Those who have suffered an addiction or know someone who has developed an addictive disorder of any type, know that these types of diseases bring about a dynamic of self-deception to continue using drugs, or carrying out the action on which the dependence is based.
In these cases, it is evident that certain mental health problems that do not necessarily belong to the scope of schizophrenia and psychosis are capable of greatly distorting our perception of the world and of ourselves. For this reason, over the years, strategies have emerged that seek to confront the person who suffers from an addictive disorder with reality. Taking this into account… Is it advisable to adopt confrontation strategies in the treatment of addiction? Let’s see it.
What do we mean by confrontation in the field of mental health?
To begin with, it is necessary to specify what we are talking about when we use the term “confrontation”. Even if we stick to the realm of mental health, it has been used in several different ways. Therefore, here we will distinguish between three different concepts that can be grouped under the umbrella of this word applied to helping people with addictions.
First of all, it is necessary to clarify that One thing is the use of confrontation in the treatment of psychopathology, and another thing is confrontational therapy. The latter is a set of addiction intervention models originating in the United States before the consolidation of psychotherapy as a resource of applied science, and which are based on the idea that it is necessary to “be tough” and brutally honest with the person who comes to treatment, sometimes even resorting to elements such as shouting, anxiety-generating warnings, and in general, forms of communication that attempt to give direct feedback and that emphasize the negative consequences that not changing philosophy would have. of life and way of seeing things.
Confrontational therapies have been used for decades for sociological reasons, and not for their validity as an effective therapy, since in fact there is no evidence that they are useful and there is much research that shows negative effects of their application. They emerged in the form of sessions carried out by people without training in health sciences, who met to help each other by creating performance-style group events to “motivate themselves” to change, inspired by examples from the field of sports and the armed forces, and As such, they are foreign to the scientifically validated design of effective psychological therapies. The most famous model of this type of supposed treatment is the Synanon Game, developed by an organization that has come to have problems with the law and be considered a cult.
Leaving aside the concept of confrontational therapy, we have the application of confrontation in a wide variety of psychotherapeutic models; In this case we are talking about much more flexible strategies based on assertiveness that have the objective of Help the patient recognize the limitations of his or her way of thinking and interpreting things from there, learn from your mistakes and progress by developing habits that make you relapse into addiction.
This way of confronting does not seek to make the patient feel guilty, feel humiliated, or feel the need to change because of the fear that an authority figure inspires; At all times, the dignity of the person suffering from addiction is respected and a therapist-patient bond is established based on equality. In short, here the confrontation is not so much what the therapist does, but rather the effect it has on the patient’s mind, who finds himself having to ask himself if it is really convenient for him to hold certain beliefs and ideas.
And thirdly, we must not forget that Most people with addictions experience different types of confrontation from family and friends ; Although they do not do it within the framework of a treatment or therapy, they often do it as an attempt to help you get out of that situation.
Does confrontation really work when treating people with addiction?
As we have anticipated, confrontational therapy does not work, but that does not mean that confrontation itself cannot be useful in the context of psychotherapy, when combined with other resources.
The truth is that because there are so many ways to confront, there is no easy answer to the question of whether confrontation is effective in treating addictions, although there is a general rule: the more assertive it is, the more useful it can be, and the more The less it is, the more counterproductive it will be.
We must not forget the fact that The majority of people with addictions show a certain ambivalence towards the pathology they suffer ; Even those who are very interested in attending therapy and improving, experience moments in which they seriously question whether it is not worth continuing in the loop of dependence and abstinence in order to not have to face months of treatment and renunciation. to drugs, gambling, etc.
In this sense, this type of patient has a certain tendency to externalize the causes of their problem; He very easily falls into schemes of interpretation of reality according to which he does not suffer from a real pathology, but rather has the problem of facing a very hard life, or very problematic personal relationships. Although it is true that many people with addictions go through very difficult life situations due to job insecurity and family conflicts, for example, these facts should not be used as an excuse to cover up the importance of addiction in itself where it exists.
Therefore, applying a very direct confrontation aimed at making the patient feel bad for having held certain ideas or certain routines. tends to have the opposite effect to that desired, since in most cases it creates strong hostility that sabotages the progress of the treatment. That is why confrontation is only recommended when it is used by focusing on the person’s potential for well-being, and not on the person’s problem.
For example, instead of using disqualifiers to refer to their way of life or their dysfunctional beliefs, it is better to ask them the right questions so that they question whether their way of seeing things is realistic and corresponds to reality, letting them be it. who reaches the conclusions that will bring him closer to facing reality. In this way, the awareness that one has been interpreting things in a less than optimal way comes at the same time as a feeling of discovery and potential for change with the help of the therapist, and there is no reaction against the person who utters hurtful or accusatory opinions.
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