A Convergence of Treatments and Ideas: Psychoanalysis Meets Harm Reduction Therapy

In this article, I describe Harm Reduction Therapy, the most current model for treating substance misuse, and I show how this approach is more consistent with psychotherapy and psychoanalysis than traditional substance use treatment has been. As opposed to the Disease Model, which has been the dominant approach, Harm Reduction welcomes anyone who wishes help with their substance use into treatment. Harm Reduction practitioners do not require that their patients embrace a goal of abstinence in order to enter treatment but work with each individual to establish the goals best suited to them. In addition, the harm reduction approach decenters substance use as a focus and instead considers the whole individual in treatment even when abstaining or moderating use is a primary goal of the work. The meaning and function of substance use is considered as well as the importance of psychodynamics, dissociation, self states and enactments. Harm Reduction therapy is based on a mutual, collaborative relationship between clinician and patient and much like any psychotherapy, the work takes place in the context of that relationship and the dynamics thereof. Clinical vignettes highlight how analytic work dovetails with substance use treatment in this relational harm reduction approach.