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.
As a professional addiction counselor and licensed psychotherapist it has been my experience that my patients who worked with me and also worked a positive 12-Step Program made much faster, and longer-lasting progress than people who only did one or the other.
Not having roots in scientific research is not a problem for us as this #Alanon 12 step program comes from spiritual principles which predate your scientific research by thousands of years. 20th century psychology is relatively new compared to that. There are basic norms to the human soul which were as true 3000 years ago as they are now. People drink, they feel guilty, they can’t stop, they feel even worse. Families suffer loss from the dysfunction of #alcoholism, they grieve, they develop anger, resentments and bitterness. The way out is to learn, grow, repair and forgive. The 12 steps provides a path out of the despair of alcoholism. There is no weakness here at all – only wisdom.
The purpose of the 12 steps is restoration to sanity from a family disease. The functional principles are sprititual and moral. The members of the groups act as mirrors in which we see our own faults and situations. Thus we grow.
In my experience, support groups, either face-to-face or on-line are enough for some to achieve sobriety. For others, especially we women, there are often underlying issues that surface that are best addressed with a trained professional, with DBT, CBT or one of my favorites is EFT.. (emotional freedom) techniques or therapy…better known as tapping.
They are all successful modalities for finding the path without substances to insulate us from reality and our feelings about it, past, present and future.