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.

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The psychology of hero worship

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Therapists, clients and trust

In a previous comment Harriet stated:

“But I am sorry that his lack of disclosure led to distrust on your part.”

This comment resonated with me and led me to muse on the topic of clients, therapists and trust. (I like words such as resonate and muse, they make me sound like I know what I am talking about!)

I mused - do I have a sense of trust or distrust with clients? The answer I came up with was in one specific sense yes, but I would say generally, no.

In my work circumstances of private practice I do trust clients in our business relationship. I deliver a service, then they pay once they have received that service. There is a small group of clients who come to therapy and have no intention of paying. Over the years I have seen all sorts of methods employed by people who are wanting to get sessions without paying for them. I never let new clients accumulate any significant debt so those who are not intending to pay may get a few sessions for free but that is all. Then they leave and I never see them again.



This indeed raises another interesting question in terms of the therapeutic relationship. If a client enters into a therapeutic relationship with no intention of paying how does that effect the therapeutic relationship. Perhaps I will muse on this some more for a later time. However in terms of our business relationship, I do have a sense of trust and distrust with a client.

Other than this the concept of me trusting or distrusting a client kind of does not make sense. In particular, as Harriet was mentioning, I don’t have a sense of trust or mistrust about a client telling me the truth and the whole truth. I just don’t see it that way. It does not ‘compute’ like that.



Clients, like everyone else have a Child ego state that is struggling to cope the best way it can, with the psychological resources it has, at a particular point in time. If the Child ego state feels it necessary to tell me a falsehood or not tell me the whole truth then I accept that. I do not feel like my trust has been betrayed by the client. I see it as them coping the best way they can.

I also know that clients, like everyone else, will behave in consistent patterns over time. I know that if a client tells me a significant falsehood about the facts of their life, then it is likely that they will do so again in the future in some way. Not because they are trying to trick me or deceive me but because they are coping the best way they can at that time. I don’t ‘win’ or lose’ anything if the client tells me the truth, just like I don’t ‘win’ or lose’ anything if the client tells me a falsehood.



Thus in relation to Harriet’s comment I don’t get led to distrusting a client if they tell me a falsehood. Instead I accept they are doing their best they can at the time and I know they may employ the same coping mechanism of telling falsehoods in the future.

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