[Show abstract][Hide abstract] ABSTRACT: The use of confrontational strategies in individual, group and family substance abuse counseling emerged through a confluence of cultural factors in U.S. history, pre-dating the development of methods for reliably evaluating the effects of such treatment. Originally practiced within voluntary peer-based communities, confrontational approaches soon extended to authority-based professional relationships where the potential for abuse and harm greatly increased. Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations. There are now numerous evidence-based alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style. It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate. Confrontation: Page 2 Treatment for substance use disorders in the United States took a peculiar turn in the mid-20th century. There arose a widespread belief that addiction treatment required the use of fairly aggressive confrontational strategies to break down pernicious defense mechanisms that were presumed to accompany substance use disorders. Although this approach was emulated to some extent in certain treatment centers outside the United States, such reliance on confrontation was predominantly an American phenomenon. As discussed below, there was some broader exploration of confrontational therapies, but nowhere did they take such deep root as in U.S. addiction treatment. Indeed, few would now regard such harsh methods as therapeutic for any other Axis I disorder in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994). What accounts for this odd detour in American addiction treatment? In this article we trace the historical roots of belief in and practice of confrontational treatment, and explore relevant scientific evidence on the effects of such methods. We then offer summary conclusions and recommendations for treatment of substance use disorders in the 21 st century.
[Show abstract][Hide abstract] ABSTRACT: Reviews the uses of videotape playback and related methods of self-confrontation in psychotherapy. This procedure has been used in group therapy (especially when the major group operation is feedback), behavior therapy, family and marital therapy, and in psychoanalytically oriented individual therapy. Methodological variations in the application are cited, involving several issues (e.g., concealment of camera, time to replay the tape, and length of a replay segment). It is concluded that self-confrontation via videotape is efficacious, helps eliminate distortion, and adds humanness to therapy. (62 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychotherapy Theory Research & Practice 01/1975; 12(2):179-186. DOI:10.1037/h0086424 · 3.01 Impact Factor
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