There’s much discussion in our field about the relative merits of 12 Step programs versus those designed around Cognitive-Behavioral Therapy (CBT) and Motivational Interviewing (MI). All have their support among treatment professionals. Underneath, however, their origins are quite different.

Go back to the birth of the Twelve Step fellowships in the founding of AA. From the beginning, it was designed to be a program for living — spiritual, yes, but also practical, a grass-roots approach based not on scientific research or professional practice but instead on the direct experience of recovering persons. That’s its strength — and from the perspective of some professionals, its weakness.

CBT and MI, on the other hand, are emphatically the products of professional psychology. CBT is in large part based on the work of clinical psychologist Albert Ellis, drawing from other 20th Century psychologists. Motivational Interviewing was developed by William Miller and Stephen Rollnick from its roots in the work of Carl Rogers.

Both were designed for use by trained, licensed professionals in conventional therapy settings.

I’ve always conceived of CBT as a box of tools (skills) for better coping. You have a problem managing anger? CBT has a protocol to address it. Need help managing craving, insomnia, conflicts with others? CBT has protocols for that, too. Rational Emotive Behavior Therapy (REBT), Ellis’ creation, is a kind of uber-approach designed to help us use our rational faculties in overcoming a host of self-defeating behaviors.

Motivational interviewing is based on the notion that the therapist’s primary task is to help the client identify and achieve his/her goals through exploration and resolution of ambivalence towards change.

All three have been shown to produce benefits when used properly in a clinical setting. But some professional therapists will always be more comfortable with CBT or MI, and less comfortable with Twelve Steps.