It represents the integration of principles derived from behavioural theory, social learning theory, and cognitive therapy. It supposes the most comprehensive approach to treating the problems derived from the use of substances. It consists of the development of strategies destined to increase the personal control that the client has over himself. The philosophy of the intervention is based on considering the client as a scientist, in the sense that he is encouraged to resort to the scientific method to test his ideas or beliefs empirically. In its application to addictive behaviours, relapse prevention therapy has been the most widely used. It was initially developed to treat drinking problems and later adapted for cocaine addicts. In it, patients are helped to recognize situations in which they are likely to use substances, find ways to avoid them and develop strategies to deal with behavioural patterns and effects of substance use. The antecedents and consequences of substance use behaviour are identified through functional analysis. Patients’ abilities to successfully face risk situations are strengthened and developed, and they are trained in relapse prevention. Analysis of cognitions and beliefs involved in addictive behaviour is included.
Brief Interactional-Strategic Therapy
In this type of therapy, an attempt is made to identify the client’s strengths and create personal and environmental situations where abstinence can be achieved. The focus is on the patient’s abilities rather than pathology. It stems from the work of Milton Erikson, who coined strategic therapy to describe an approach in which the therapist takes responsibility for finding effective strategies to help patients with panic disorders.
Berg and Miller were the first to use this approach to treat alcoholism. It is not considered a useful approach for all patients, but it is considered a set of techniques that can be used within a treatment package.
It is pointed out that the therapists should direct the patient’s attention to the periods in which he was abstinent and ask him to discuss those periods, making him see that he can maintain himself without consuming as he did in the past. The therapist works closely with the patient to understand the patient’s perspective on his problems, which he considers important (relationships, work, finances, etc.) and helps him understand how substance abuse affects those areas, reinforcing the successes as the patient works through his problems.
These therapies have a constructivist vision of reality; they affirm that it is determined by individual perceptions that are influenced by cultural, sociopolitical and psychological factors. A basic principle of this approach is to affirm that human problems can be understood by applying the principles of the human system. Problems do not exist in a vacuum; they exist because of relationships with one another. The strategic therapist believes a positive change in one part of the system will positively affect the rest.
The basic principles of the approach are as follows:
- Focus on competence rather than pathology.
- Find a unique solution for each case.
- Use exceptions to the problem to open the door to optimism.
- Use past successes to build confidence.
- Look at the patient as an expert.
- Use goals and use trajectories to change.
- Share responsibility for change with the client.
Brief Humanistic And Existential Therapies
Humanistic and existential psychotherapies use various approaches in case conceptualization, therapeutic goals, intervention strategies, and research methodology. They emphasize understanding the human experience and focusing on the client rather than the symptom. Psychological problems (including substance abuse) result from the inability to choose the most appropriate way of life.
Whereas the keywords in this type of approach are acceptance and growth, the important themes of existential therapy are the client’s freedom and responsibility. Humanistic and existential approaches share the belief that people have the capacity and awareness of choice. However, the two schools arrive at this belief through different theories. The humanistic perspective considers human nature with an inherent potential to stay healthy and the capacity to make choices in the interest of oneself and others. The focus of therapy is directed towards personal growth instead of focusing on possible disorders. The therapeutic relationship serves as a vehicle or context in which the process of psychological growth is fostered.
The existentialist perspective is more interested in helping clients find philosophical meaning, to think and act authentically and responsibly. The source of the problems is the concern for loneliness, isolation, despair and death.
Many humanistic and existential approaches (empathy, caring, reflective listening, acceptance) are useful in any therapy as they help establish rapport and commitment to all aspects of the treatment process.