Monday, January 13, 2014

Saturday, January 11, 2014

Some therapeutic observations of the AA approach

Having worked with many who have embraced the AA approach as a way to stay clean and sober I find I am left with  some favorable comments to make about it.

Regardless of whether one agrees or not with the ideas of a higher power being responsible for one’s alcoholism or substance use I intend to just look at the some aspects of the AA approach irrespective of the underlying philosophy.

At the moment I am working with a number of people who are in the maintenance stage (of the stages of change model). They have been clean and sober for a number of years ranging from 2 to 10 years. With all of them the possibility of their relapse arises from time to time and represents a fear to them in varying degrees.  

In my view the way they have learnt to use the AA approach which makes it particularly suitable to the individual who is in the maintenance stage.

1. The self regulating aspect of the AA approach. As it is free and available everyday of the year one can regulate their own attendance at meetings. It can range from once every few months to a number of times daily.  When their maintenance is a bit shaky commonly they will increase their rate of attendance at meetings.

In most counselling situations this can not occur. It may get too expensive and most often the person has to make appointments with the counsellor such that they have to wait days if not weeks to meet. Even if it is free or they can afford it most counsellors don't really see the same client a number of times a day or every second day and so forth. In most counselling situations the ability for the person to self regulate contact is not permitted in the same way it is with AA.

2. The sponsor system. In my view another helpful aspect of AA that is used well by some of those at the maintenance stage to assist with their sobriety. The fact that they aren't trained counsellors and bound by lists of codes of conduct actually has a positive result in one way. It allows for a truly mentor type of relationship that one can only get with that type of informality. 

The formal therapeutic relationship between client and therapist actually creates quite a rigid structure in the relationship. In addition AA sponsors tend to have much more flexibility in their availability of contact. One of the reasons being that they have far less people ('clients') to be available to. This again allows for a person to self regulate their contact with the sponsor as they feel the need (at least to some degree). In the usual therapy relationship this self regulation by the client is far less flexible, again highlighting the rigidity one finds more in the usual therapeutic relationship.

The 12 step programme. At times those seeking to maintain sobriety can put themselves back onto the 12 step programme (self regulation again). With their sponsor they start again at step one and go through the programme. This seems to provide some with a more secure base. It gives them something to focus on and do that they see as protecting self. Also it is not a short programme taking, not days or weeks, but months. The individual places self on a long process which they see as part of their arsenal to fight addiction thus feeling protected in this sense. And as I said before it gives them something to focus on and do instead of using alcohol or drugs. 

Overall I have found some at least use the AA (or NA) approach in these ways which certainly helps them to remain clean and sober.

The other thing which must be noted is that AA is not therapy and is not attempting to be therapy. At least in the sense of helping people to resolve their childhood traumas, make redecisions, deconfuse and decontaminate and so forth. This raises an interesting issue. Is it possible to take some of these positive aspects of AA and weave them into a form of mentor relating? I purposely don’t use the word therapy because as soon as you do that you immediately impose all sorts of conditions and implications on the process and hence you loose the flexibility and as I said end up with quite a rigid relationship style.

Is it possible to find an in between ‘spot’. You are not therapist and client but you have two people relating who happen to be a therapist (which I will refer to as a mentor) and a clean drug user. The relationship would allow much more flexibility in how the ex user can contact the mentor and the mentor does not have to respond in a therapeutic manner.  Instead one could develop some kind of ‘step’ programme like AA has and the ex user and mentor could do that as well of course the relationship things which would firm up the person’s resolve not to use. Of course this could only be done with a very few ex users as the mentor would become over loaded. Also of course ti would not have to be kept to just drug and alcohol use problems.