Sustaining Transference in the Treatment of Alcoholism

Psychoanalysis is not usually considered to be an effective tool in dealing with alcoholism. It is a therapy mode that is rarely sought by the alcoholic, and is looked on with disfavor by the alcoholism treatment community. The image is often of the cold, intellecutual and emotionless analyst, who is primarily interested in the past. Some of these preconceptions are true: the analyst is there to analyze rather than to gratify. People with impulse disorders, such as alcoholism, are likely to attribute coldness and lack of concern to anyone who is not gratifying.

Most treatment of alcoholics deals with trying to improve the alcoholic's life, and solving the problems created by the drinking. While this process may be gratifying enough to the patient to keep him in treatment for a while, the underlying impulse disorder is not addressed. I have found in my work that the alcohlic does need gratification from the analyst. If the analytic situation is experienced as too frustrating, the patient will either leave treatment prematurely, interminably continue the drinking pattern, or discover some new way of destructively acting out his impulses. Traditional analytic approaches need to be modified, then, so that sufficient gratification can be provided to prevent a more serious regression or termination of the treatment. The amount of gratification provided needs to be delicately balanced, however, between too little and too