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The essence of harm reduction is meeting people where they’re at.

Central to this approach is the idea that—at all costs—the therapist should do their best not to impose their values or preconceived ideals onto the client.

When a client starts working with a harm reduction psychotherapist, the basic frame of the therapy is:

(1.) What are your goals?
(2.) And how can I be of service to you in helping you to achieve them?

In other words, you’re not trying to change the client.

You’re extending a helping hand to them to begin a process of healing with you - at exactly the place they’re at in life.

So you ask them things like:

1.) What’s your current relationship with the substance and/or behaviour?

2.) Would you like to change your relationship with it at all?

3.) And if so, what might that look like?

This is a starting point, where small changes gradually lead to more substantial ones.

Key to all of this is the recognition that the addiction is one of the central sources of meaning in the client’s life.

So if you ask them to give it up cold turkey, you’re going to be met with a lot of resistance - which makes perfect sense. (If someone asked you to give up everything in your life that was bringing you joy - how would that feel?)

A good way to think about this is to imagine signing up for your first ever gym membership and that you had very little previous experience with exercising. Now, after signing up, the gym informs you that it’s mandatory that you run a marathon the following weekend, or you’ll lose your membership.

Sounds ridiculous, right?

Well in a lot of ways, that’s what abstinence only approaches do—and this might explain why its failure rate is so high.

The harm reduction approach is to start slowly and gradually help the client develop other sources of meaning outside of the addictive substance or behaviour, so that it becomes only one of many sources of meaning in their life.

Over time, as the client slowly starts to build a life worth living with an ecosystem of meaningful relationships and activities, the source of the addiction starts to lose its value and prominence.

As the client develops deeper, richer, and more sustainable sources of meaning outside of the addiction, they can gradually reduce their dependence on it, and may eventually let it go entirely.

Book recommendation: https://amzn.to/46qW0hs

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