Yolanda Nally, An Integral Approach To Psychotherapy


Harm reduction is a framework for helping drug and alcohol users who cannot or will not stop completely-the majority of users-reduce the harmful consequences of use. Harm reduction accepts that abstinence may be the best outcome for many but relaxes the emphasis on abstinence as the only acceptable goal and criterion of success. Instead, smaller incremental changes in the direction of reduced harmfulness of drug and alcohol use are accepted.

Harm reduction places respect for the client's strengths and capacity to change as the starting point for developing egalitarian relationships in which clients are encouraged to collaborate in setting up the treatment and choosing goals and strategies that they find useful.

This is a very compassionate approach that truly "meets the client where they are". This integration of psycho dynamic, cognitive, behavioral, and biological strategies is a client-centered approach that honors the uniqueness of the client and the personal and individual meaning the substance use has for them. In this way, we can move forward in a non-judgmental fashion in helping the client improve all areas of their life.

The assumption that abstinence is the only cure for addiction is related to the addiction-as-disease concept. According to this model, people with substance use problems cannot benefit from psychotherapy while they are using, must accept abstinence as a goal of substance use treatment to be in treatment, and must achieve and maintain abstinence in order to be allowed to remain in treatment.

With harm reduction, the client is met pragmatically and with compassion. Substance users are engaged where they are, not where the therapist thinks they should be. In effect, harm reduction follows the client's nature rather than asking the client to match imposed treatment demands. It recognizes that substance use and its consequences vary along a continuum in the direction of decreased harm. Therefore, any reduction in harm is seen as a step in the right direction. For many users, abstinence is considered ideal in terms of reduction of harmful consequences, but alternative goals that "step down" the negative consequences of substance use are also embraced.

As an approach that emphasizes compassion, harm reduction actively challenges the tendency in our society to deal with drug and alcohol users in stigmatized, disrespectful, coercive, and punitive ways.

Tatarsky, A. 2002. Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems Bowman and Littlefield, UK

Center for Integrative Psychotherapy
Yolanda Nally, L.C.S.W., EMDR II
(479) 459-7341
230 W. Center
Fayetteville, AR 72701

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