Is sobriety a condition for therapy?

New Zealand

Is sobriety a condition for psychotherapy?

This is a question that faces many psychotherapists in the course of their careers. When a patient presents for therapy and the patient has an active relationship with a substance, does the therapist challenge this relationship? Can psychotherapy continue when a patient is under the influence of the substance in his or her daily life?

In my own practice, I've encountered this question, and have come across two approaches. One approach recommends abstinence in order for psychotherapy to be effective, as the patient needs to avail themselves to the psychotherapy process without the substance which could derail the process and cloud ego development. Another approach views use of the substance like any other symptom in the patient's life, which will resolve once the underlying difficulties have been worked through. The patient is seen as needing the substance for self-soothing and self-regulation, and the idea is that once the patient attaches to the therapist and begins to internalise the therapy, the need for the substance will abate and be replaced by a renewed capacity to face reality.

Dan Wolf, Director of Houghton House Addiction Recovery centres, shares his view here. If you're interested in his full talk on working with addiction, worth 3 CPD points, click here.


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