Skeptical Attunement: Modifying Psychodynamic Technique for Substance Abuse Treatment

Abstract

ABSTRACT Despite enormous advances in the field brought on by psychology's reintegration, modern substance abuse treatment fails to adequately treat substance abusers' emotional lives. Objectives: Psychodynamic technique can fill this gap by addressing the emotional discomfort and disconnection that underlies much of substance abuse. Methods: A new model of substance abuse treatment integrating psychodynamic technique with recent developments in addiction treatment (harm reduction, relapse prevention and cognitive-behavioral therapy, motivational interviewing/motivational enhancement) is described with examples from a clinic in the Bronx currently using this method with positive clinical results. A modified version of psychodynamic technique is described in which the clinician is more active and symptom focused, addressing both emotional issues and symptoms of ongoing drug use. Skeptical attunement is the use of healthy skepticism as a means of confronting the patient in a way that is experienced as empathic attunement, leading to more meaningful therapeutic work. Results: This model has proven efficacious in a low-income community. Patients showed an increased awareness of their feelings, ability to identify how feelings can lead to action, and awareness of how physical and emotional reactions can trigger cravings and relapse. Conclusions: This model has implications for full substance abuse programs as well as private practice settings.