An Article by George Taylor MFT
Alcoholics and Psychotherapists:
An Analysis of Counter-Transference Issues
I have noticed two broad trends in therapists’ responses to alcoholics. First, therapists do not assess the alcohol or drug issues in their couples. (Conservatively, one out of ten clients is wrestling with addiction issues, so 20% of our couples are as well.)
The alcohol user, whose main job is to defend his/her using, is not going to bring up the issue. The co-alcoholic experiences some despair, since all their efforts to control the drinking behavior have failed. Often they have disincentives to raise the topic as well.
Therapists who do not to take the initiative and do an addictions’ assessment are aligning with their clients’ state of denial.
Second, once the issue of alcoholism is raised in treatment, it is easy for the therapist to work too hard to get the clients to change. (I know this one well myself.) These clients, stuck in their suffering and false beliefs, challenge our own grandiosity as healers.
It is exhausting to give the alcoholic reading materials, to help them find AA meetings, and to make brilliant interpretations of their childhood experiences.
Then the alcoholic continues to drink. (Don’t forget: Alcoholism is, among many other things, a disorder of thoughts.) The exhaustion can lead the therapist to thoughts of incompetence, and to feelings of anger at the addict.
The addict is used to this angry pressure, and it rarely succeeds in shocking him/her into sudden awareness. The alcoholic has to ‘bottom out’ which means really feeling the depth of injury he or she is creating.
The spouse of the alcoholic can also bottom out, when he or she can no longer tolerate the suffering. At this point, the co-alcoholic begins to make a stand, and say what they want and need. The authentic honesty of the co-alcoholic can change the family system radically.
It takes a long time for a therapist to learn how to walk the line between denial and subtle coercion, but this balancing act makes working with these clients much easier.
The recovery rate for alcoholism is low and the relapse rate is high, but therapists often set the bar too high. We can offer guidance, education and a process of setting limits, interventions which will work, only sometimes.
(This is a first pass at counter-transference issues. There are many more issues here, embedded in the arc between the therapist’s powerlessness and grandiosity.)