You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Alcoholics cannot tolerate a delay in beginning treatment. Therefore the complete psychiatric history, physical examination, and psychological tests should be deferred. The ego strength of the patient must be carefully evaluated. The alcoholic uses a variety of defenses against anxiety: denial, evasion, projection, withholding of data, and flight from therapy. Crises are frequent, particularly bouts of drinking; the therapist must expect these and not become discouraged. Drinking after abstinence may mean that the patient's capacity to master some external or internal pressure is under such strain that he seeks the readiest means of escape. Other irrational influences affect therapy: the wife or mother of the patient objects for neurotic reasons to the patient's continuing; an employer becomes impatient to see results and upsets the therapy by discharging the patient or by insisting on having some contact with the therapist; excessive drinking involves the patient in trouble with the police and the therapist must intervene. In spite of the obstacles many cases can be helped, and work with the alcoholic patient has its rewards. The therapist of alcoholics should be free of moral opinions about drinking. He must have patience and the capacity to continue in spite of persistently bad results, and be willing to work with cases of poor prognosis. He must be emotionally prepared to set limited goals and to be satisfied in many cases with symptomatic relief rather than dramatic change of character. It is of paramount importance that the therapist be free of unconscious attitudes that may encourage his patient to regress.