Bread, flour, milk, butter, eggsListening to a discussion of the relative merits of different approaches, I found myself wondering: what has each contributed to our understanding of treatment and recovery?

If somebody held a gun to my head and forced me to put it in a sentence, I mean.

The 12 Step approach— This one isn’t hard: It’s the notion that an alcoholic/addict ensures his own recovery by helping others find theirs. What a breakthrough that was. Nowadays it’s even got a name: the helper therapy principle. And it’s copied in the treatment of other chronic disorders, both medical and mental health.

Cognitive-behavioral therapy— To me, this is the idea that through science we can develop new skills for coping with depression, anxiety, etc. Seems like common sense, but back when I started, it was pretty revolutionary.

Motivational interviewing— The realization that rather than creating change, excessive confrontation could actually impede it.

Those weren’t the only contributions, but at the moment, they seem to me to be key ones.

Visit a treatment center and you’ll likely see echoes of all three approaches. Not in equal parts– most clinicians prefer one or another. But all present and accounted for, nonetheless.

Clinicians are adaptable. They cut and paste to find what works best for most, and use that. And they struggle to come up with meaningful statistics about what they do. To a clinician, a question about outcomes is about how client Bob is doing with his divorce and whether Phyllis has found a safe place to live and why Morrie missed last week’s session and didn’t call.

It’s not about the numbers.

Counselors spend their lives dealing with other peoples’ emotions. That’s the language they speak. Stats are something we impose on them when there’s already another client waiting in the corridor and the charting still isn’t done.

Counseling is a messy process. Like recovery itself, I guess.


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