12-Step Recovery and Therapy, Part III: Using these ideas with clients

Many clients come to therapy because A.A. wasn’t enough for them to stay sober.  Many other therapy clients struggle with issues that bear little resemblance to an addiction of any kind, let alone an addiction to alcohol or drugs. Yet, many of these clients have benefited greatly from thinking about things and exploring their lives and themselves in ways that stem from the same kind of approach used by A.A. and similar 12-step programs for alcoholics. I hope I don’t sound like a one-trick pony—like a guy who learned the 12-step approach and now offers that, just that, to anyone and everyone, thinking it’s a one-shoe-fits-all kind of thing.  That is not me at all. There are many modes of therapy; many tools, approaches, philosophies, theories, any one of which or any combination of which might be the best for any particular client in any particular state. The 12 steps are just one approach and there are many others I use every single day as a therapist.  I am only making the point that the 12 steps are often not enough for those who are trying to stay sober and the 12 steps can also be helpful for those who are not even in therapy to stay sober or because someone in their family is struggling with sobriety.  I try to incorporate all of these various tools into the way I help people in therapy, and do not limit my approach based on whether someone is in therapy struggling with addiction or some other mental health issue.

In the last blog, I boiled down my approach to sobriety this way: “Make a searching and fearless moral inventory of yourself, with rigorous honesty, and do this in everything you do in your life, all the time, twenty-four hours a day, every day, no exceptions.”  Notice that this statement about living your life actually says nothing at all about drinking, drugs, gambling, or any other kind of addiction.  In a previous blog on what constitutes “Mental Health,” I suggested it amounted to something like having the ability to address your internal self, no matter how difficult.  Well, that sounds pretty similar to a “fearless and searching” inventory of ourselves.

So, what’s with the “moral” part?  In addiction recovery work, there is a fundamental problem that addicts can often suffer from extraordinary guilt, which can be a primary motivator for continued drinking (to temporarily escape the guilt when we are drunk).  Alleviate the guilt, and you alleviate a big part of the reason to drink. Makes sense.  Makes sense for alcoholics, and anyone else who suffers from guilt, whether they are alcoholics or not.  Think about it this way.  The DSM (Diagnostic and Statistical Manual of Mental Disorders) created by the American Psychiatric Association lists “inappropriate guilt” as one of the leading symptoms of Major Depression.  So, a person who’s guilt is a leading cause of their depression, might do very well to root out where the guilt comes from, by engaging in a “fearless and searching moral inventory of themselves.”  When we do this in therapy, they often find that much of their guilt is “inappropriate” because they are holding themselves responsible for all kinds of stuff even though it wasn’t their doing and they had no control.  Again, even when a depressed client finds they feel legitimate guilt about stuff in their lives, they might be depressed because they don’t know how to let go of the guilt, or what to do about it.  The 8th and 9th steps of A.A. are great tools for this situation.  Step 8 is “Made a list of all persons we had harmed, and became willing to make amends to them all.” Step 9 is “Made direct amends to such people wherever possible, except when to do so would injure them or others.”

When I was in graduate school earning my therapy degree, they taught us a version of this very thing, only they taught it using different language, and taught it as part of what they called “Narrative Therapy.”  Okay, whatever you want to call it, these ideas can give people powerful tools to really determine whether they feel bad for stuff that isn’t their fault or they feel bad for stuff that should make them feel bad but they don’t know what to do about it and are stuck in their lives over it.  I often use these tools to help adults who struggle with issues of guilt over disappointing their parents’ expectations of themselves by suggesting they right a letter about this to their parents and then either read it or discuss it with their parents, or bring it to therapy so we can take a closer look at whether those expectations are really worth trying to meet.  I could cite many other examples of the ways just these two steps, Steps 8 and 9, are helpful to a wide variety of therapy clients, including those who struggle with addiction and those who do not.

When someone struggling with addiction comes to see me for therapy, one of the first things I tell them is: “I am not going to be your ‘sober cop.’” Those of you who are reading this blog who came to see me for addiction issues are probably chuckling to yourselves right now as you remember our first session talking about this.  I say it with all seriousness, though.  I tell them that I want them to do what they need to do to stay sober, whether that means going to an A.A. kind of program or some other program. If they decide to go the A.A. route, I suggest they find at least one group they can attend every week (a “home group”), work the steps as they see fit, and get an A.A. “sponsor” (someone who is in A.A. and can help them figure out how to apply the steps in their lives).  Beyond those suggestions, their recovery from addiction is mostly up to them. I further explain that, in a way, my role as their therapist begins where the steps end, that I can help them increase their self-awareness beyond what they might be able to do using the 12 steps alone.  I see my role in their lives as supporting them in discovering why they drink, use drugs, gamble, and what parts of their lives might still encourage them to do so.  A.A. and other 12 step programs certainly do this to some extent, but many people have issues that they may not want to share with a group of strangers at an A.A. meeting. Or, they may find they need more targeted guidance at understanding the issues that helped to create or sustain their addiction and the consequences of that addiction (e.g. marital conflict).  With these clients, I might use some parts of the 12-step process, as they deem it appropriate for them. I also use many other therapy tools and ideas with these clients as well, just as I would with any other clients.

I want to modify my previous statement about how I try to live my life as a sober person by adding to it part of Step 7 of A.A., which says, “Humbly asked Him to remove our shortcomings.”  The word “Him” is supposed to refer to God, but it is commonly accepted in A.A. that you can replace God with anything you consider your “higher power.”  At times in my own sobriety, when I’ve struggled with my own spirituality, my “higher power” was as simple as the other people in A.A., helping me to figure out what I needed to do to stay sober while they were figuring out their own sobriety issues. Step 7 is important because it encourages us to be “humble.”  The importance of humility is all over A.A., not just in the steps.

I use humility as a potential tool with all my clients. A good example of a client issue where humility is really important is when a client feels responsible for things in their life over which they have little or no control. This can lead to serious anxiety issues, guilt, co-dependency, compulsive behaviors like excessive working hours and addictive behaviors like drinking, drugs gambling, sex addiction, etc. (which is why is it is a vital part of 12-step recovery in A.A. and similar programs).  I even use humility myself as a tool to monitor the amount of responsibility I take on for my clients’ issues.  I want to be responsive and engaged with my clients in helping them find solutions to their problems.  I do not want to make the mistake of thinking I am responsible for solving their problems. That is disrespectful to my client because it falsely assumes they can’t solve their own problems. Lack of humility in my therapy work would also weigh on me and make me think I am more important than I really am.

The point of these blogs on 12-step recovery and therapy has been to clarify for myself and for my clients that, while I have many different approaches that guide my work with a client, depending on what they need, I cannot deny the importance of my own experiences in using the tools of 12-step recovery in my own life.  I do not believe in a one-size-fits-all approach to much of anything having to do with how humans live and what they need.  We are all really different.  I respect that and admire it, especially when I see others find their own way, gathering around them unique resources and strengths to cope with their various issues. There are, though, some universal themes that seem to help clients in their struggles. These include self-awareness, honesty, consistent practicing of what we learn, reaching out to others, and humility.  All of these themes are incorporated in the 12-steps and can benefit just about every one of us.

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