(See
the new aacultwatch forum)
“Learning
from the US experience of Twelve Step Facilitation continued….
The
Synanon cult philosphy and Hazelden 12 step philosophy
The
following are extracts from “Confrontation in Addiction Treatment”
William R. Miller, PhD and William White, MA
http://www.cafety.org/sites-we-like/755-confrontation-in-addiction-treatment
The published paper is also available in pdf: The use of
confrontation in addiction treatment: History, science and time for
change. White, W. & Miller, W., 2007, Counselor,
8(4), 12-30)
http://www.williamwhitepapers.com/pr/2007ConfrontationinAddictionTreatment.pdf
“…Synanon’s
role in the history of confrontation in addiction treatment is a
crucial one. Synanon’s aggressive confrontation techniques were
transmitted to second-generation therapeutic communities (TCs) such
as Daytop, Phoenix, Gateway, Gaudenzia, The Family and Walden House,
and were then widely diffused into the larger emerging treatment
system in the 1970s. The thousands of professionals trained by
Synanon and the immense popularity of Synanon’s “game club”
(Synanon-facilitated groups for non-addicts) spread confrontational
techniques into broader schools of psychotherapy and into the larger
human potential movement of the 1960s and 1970s…”
Confrontation
in the Minnesota Model
“In the late 1940s and early 1950s, a synergy between three alcoholism treatment programs — Pioneer House, Hazelden and Willmar State Hospital —birthed an approach to the treatment of chemical dependency that was widely replicated in the following decades. Confrontation was not a technique used within the original Minnesota Model, but was gradually introduced in stages. The first stage was the emergence of “tough love” — a concept from Al-Anon that when interpreted within the treatment context, argued that the alcoholic needed to be confronted directly about his or her behavior and held accountable for the consequences of that behavior. An important corollary was the concept of “enabling.” This concept depicted well-intentioned attitudes and behaviors exhibited by those around the alcoholic that, by protecting the alcoholic from the consequences of his or her behavior, inadvertently sustained the alcoholic’s drinking and related problems.
While the concepts of tough love and enabling eased the way for the introduction of confrontation techniques, it is surprising that group confrontation would emerge within a model of treatment so heavily influenced by AA. AA and the peer-based lay psychotherapy models that preceded it were distinctly non-confrontational, with AA even discouraging crosstalk at its meetings. In the AA meeting culture of the 1930s and 1940s, members did not provide direct feedback or advice to one another, but responded to any disclosure by sharing their own related experience. Confrontational therapies are clearly not rooted in the origins and core literature of AA .
Confrontational techniques emerged within Hazelden as staff sought new ways to engage and manage a subset of clients they perceived as having severe characterological problems. In the late 1960s Hazelden began treating younger opiate and polydrug addicts whose behaviors were harder to manage within the treatment milieu. Seeking solutions to this dilemma led Hazelden staff to visit Eagleville Hospital in Pennsylvania which was pioneering “combined treatment” (integrated treatment of alcoholics and addicts). Eagleville had emulated the confrontation techniques of Synanon, Daytop and other early TCs and became the conduit for introducing these techniques at Hazelden. Openness to such confrontation techniques at Hazelden came in part from working with addicts who were perceived as “sicker” and harder to reach.
“In the late 1940s and early 1950s, a synergy between three alcoholism treatment programs — Pioneer House, Hazelden and Willmar State Hospital —birthed an approach to the treatment of chemical dependency that was widely replicated in the following decades. Confrontation was not a technique used within the original Minnesota Model, but was gradually introduced in stages. The first stage was the emergence of “tough love” — a concept from Al-Anon that when interpreted within the treatment context, argued that the alcoholic needed to be confronted directly about his or her behavior and held accountable for the consequences of that behavior. An important corollary was the concept of “enabling.” This concept depicted well-intentioned attitudes and behaviors exhibited by those around the alcoholic that, by protecting the alcoholic from the consequences of his or her behavior, inadvertently sustained the alcoholic’s drinking and related problems.
While the concepts of tough love and enabling eased the way for the introduction of confrontation techniques, it is surprising that group confrontation would emerge within a model of treatment so heavily influenced by AA. AA and the peer-based lay psychotherapy models that preceded it were distinctly non-confrontational, with AA even discouraging crosstalk at its meetings. In the AA meeting culture of the 1930s and 1940s, members did not provide direct feedback or advice to one another, but responded to any disclosure by sharing their own related experience. Confrontational therapies are clearly not rooted in the origins and core literature of AA .
Confrontational techniques emerged within Hazelden as staff sought new ways to engage and manage a subset of clients they perceived as having severe characterological problems. In the late 1960s Hazelden began treating younger opiate and polydrug addicts whose behaviors were harder to manage within the treatment milieu. Seeking solutions to this dilemma led Hazelden staff to visit Eagleville Hospital in Pennsylvania which was pioneering “combined treatment” (integrated treatment of alcoholics and addicts). Eagleville had emulated the confrontation techniques of Synanon, Daytop and other early TCs and became the conduit for introducing these techniques at Hazelden. Openness to such confrontation techniques at Hazelden came in part from working with addicts who were perceived as “sicker” and harder to reach.
In 1967, Hazelden started a “Repeaters’ Program” and began using a peer evaluation (“hot seat”) technique within the group therapy session on this unit. In this technique, a member of the group occupied a center chair within the group, and his/her attitudes and behaviors were critiqued by other group members using an inventory sheet of 23 items, 22 of which were character defects; e.g., resentful, prideful. By the mid-1970s, the use of the “hot seat” technique had spread to all units at Hazelden and commonly included the use of derogatory language and labels. This technique was spread into the larger field by former Hazelden staff and the large numbers of people who received training at Hazelden.
In the late 1970s, the use of confrontation was re-evaluated at Hazelden. The use of the “hot seat” in the women’s units was stopped when it came to be viewed as too harsh and disrespectful. The use of confrontation on the men’s units also changed. A new inventory was integrated into the peer evaluation process that included character assets, and the person being evaluated was moved from a center chair to a chair within the group to reduce his or her vulnerability. To emphasize this change, the “hot seat” was re-
christened the “love seat” and an emphasis was placed on the use of “compassionate confrontation.” By 1985, Hazelden was already describing confrontational counseling as a thing of the past:
There was a time when the dominant mode of chemical dependency treatment was based on a “tear ‘em down to build ‘em up” philosophy. . . Counseling sessions sounded disrespectful and dehumanizing. And they were . . . Patients . . don’t need to be “put down” to deal with symptoms . . they need to be treated as individuals, with the same rights and respect we expect for ourselves. We’re concerned because many treatment programs still use these confrontational techniques. Some even call themselves Hazelden or Minnesota models. It’s true that we once used confrontation. But we found a better way (Hazelden Foundation, 1985)…”
“The
scope of the problem is difficult to document. It is hard to know
exactly how prevalent the tough love philosophy is and how common its
extreme forms are – but sociologist Elliot Currie, who has studied
teen residential programs, says the view is so pervasive that he
cannot ‘confidently’ say that he knows of any programs which are
not influenced by it.” (Maia Salavitz “Help at any Cost, How the
Troubled Teen Industry Cons Parents and Hurts Kids”, (Riverhead
Books,
2006.) http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=Help%20at%20any%20Cost%2C%20How%20the%20Troubled%20Teen%20Industry%20Hurts%20Cons%20Parents%20and%20Hurts%20Kids”
Note:
Conference Questions can be downloaded in pdf from the GSO (GB)
website. They are on pages 5-11, AA Service News, Issue 157,
Winter 2013
http://www.alcoholics-anonymous.org.uk/download/1/Library/Documents/AA%20Service%20News/157%20Winter%202013.pdf
Conference 2014 background material can be found on the GSO (GB) website. Follow the “Background Material for Conference 2014” link in the Document Library. http://www.alcoholics-anonymous.org.uk/Members/Document-Library
Cheers
The
Fellas (Friends of Alcoholics Anonymous)
PS
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