A Psychodynamic Perspective on the Efficacy of 12-Step Programs

Abstract

The author reviews recent developments in psychoanalytic and psychodynamic theory and practice and their applications to understanding and treating addicted individuals. Emphasis is placed on experience near, more interactive, and empathic approaches stressing structural, self-psychology, object relations, and attachment theory in contrast to early classical psychoanalytic models that were impassive, detached, and more strictly interpretive in their methods. The contemporary models are adopted to explain and provide a basis for explaining how and why Alcoholics Anonymous works. From this perspective, addiction is understood as a self-regulation disorder involving difficulties in regulating emotions, self-esteem, relationships, and behavior and how the working of AA address and correct these vulnerabilities.

KEYWORDS:

• Psychodynamics
• self-regulation
• feelings and story telling
• self-esteem
• relationships
• group dynamics

Notes

¹ This section is based in part on a recent presentation as the 20th John Bowlby Memorial Lecture titled, The Self-Medication Hypothesis and Attachment Theory: Pathways for Understanding and Ameliorating Addictive Suffering.

² This section in part is based on two previous publications: Khantzian & Mack (1994) and Khantzian (1995b).