This issue focuses on youth and families, including evidence-based treatment and group counseling for adolescents, and treatment for high-risk families. The emphasis now is on evidence-based practices, the science of treatment. The great psychotherapy debate today is whether therapy is an art or a science. And the answer is, yes; it is both an art and a science.

I highly recommend two books on this subject, Hubble, Duncan and Miller’s The Heart and Soul of Change (1999), and Wampold’s The Great Psychotherapy Debate (2001). These books demonstrate that therapy combines both evidence-based practices (or as I prefer, practice-based evidence) and the art of forming relationships with the client. It is not an either-or but a both-and world. One thing is clear from the data: the road to recovery runs through the therapeutic relationship. Research has shown that the single most important factor in the treatment of adolescents, families, and adults is the quality of the therapeutic alliance between counselor and client.

What typically happens in the formation of ideas and treatment models is they follow a certain process. (Please excuse the sexist language but it works for alliteration). Psychotherapeutic models begin with a good idea, always with a charismatic man or woman who brings to life an idea and excite others. So we start with a MAN. Based on the success of that person, it becomes a MOVEMENT that lauds the success of that approach. We form training courses and schools to teach others how to practice that model of counseling. The founding mother or father of the approach goes out on the lecture circuit teaching others about her model. From there we MANUALIZE the model. A common trait today in psychotherapy is manualized therapy. If we design a codebook that gives step-by-step instructions, we believe we can teach people what the creator of the model once did. Finally, we create MONUMENTS and MUSEUMS to honor the founder and model.

However, we lose sight that all good ideas begin with a person, and all good work in therapy begins with the therapeutic alliance between persons — between a counselor and client. Always! The quality of the relationship is the single best predictor of therapeutic outcome.

We also forget that “the love hungry brain will seek relief in either substances or relationship” (Jeff Georgi). The most important gift we can ever give a client is not our therapeutic model (although it is important to be grounded in a model). It is not our technique as a therapist that heals. Technique is what a therapist uses until the real therapist shows up. What brings change is offering our clients a compassionate, caring relationship, provided in a safe and caring environment. People do not care how much you know until they know how much you care.

Further, instead of seeking relief of symptoms when treating substance abusers, we need to seek transformation of pain. Clients come to us in pain. If they do not transform their pain they transmit it, onto themselves and others, by drinking and use of substances, by hitting one’s partner or children, by kicking the dog, etc. Therapy ought to be about transformation of pain.

How do we transform pain in our lives? There are three key steps:

1. Transformed people transform people. Before you can help another person to be healed, heal yourself. You cannot take a patient to a place you have not been. Counseling is about attraction. Clients should see something in you they want. Whatever you have, whatever you’re on, they want to be have, to be on. So, to be a better counselor, deal with your own pain and wounds first. Transform yourself.

2. Love transforms pain. Love is not a word we are taught in psychotherapy school, but counselors need to offer their caring, compassion, and yes, love, to clients. How do we do that? We show our caring through our presence, being with the person in the pain. Instead of being distracted by other things (the pile of paperwork sitting on your desk that needs to be done, what to cook for dinner, bills needing to be paid), we sit with the patient, fully present and mindful of the present moment. Honestly, I have wasted far too many hours in counseling thinking about other things and not being “with” my client. So, before you enter your next counseling session, clear your mind, calm your heart. Begin with an attitude of gratitude and thanksgiving. To show caring and love to another we need to begin with a settled mind and body. (I will write more on this subject in future columns).

3. Community creates love. That is the power of 12-step meetings that offer healthy, healing communities, where people who have been broken share their experience, strength and hope. Create a healing community with them, providing them a safe holding place where their pain can be transformed. The Greek word for “therapy” is rooted in the word “to harvest,” with images also of the word “womb.” What a wonderful image for counseling, to harvest what is already there through creating community, a womb of loving, caring people.

So, how do we counsel youth, adolescents, and adult substance abusers? Build relationships, help them transform their pain, demonstrate your caring and love in all you do with them, and create a healthy community around them. Remember, the road to recovery always runs through the relationship.

David J. Powell, PhD, President, International Center for Health Concerns, Inc., is an internationally recognized lecturer and trainer, and author of Clinical Supervision in Alcohol and Drug Abuse Counseling. His most recent book is Playing Life’s Second Half: A Man’s Guide for Turning Success into Significance. For further information, contact This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or www.ichc-us.org.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2006, v.7, n.2, pp.26-27.

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