Since the beginning, this column has reported only on research-supported addiction counseling practices. After nine such reports, this edition will report on practices that do not have research support.

Knowing what has little or no support is as important as knowing what does. Clinically, the idea is to think carefully about exposing your clients to strategies and interventions that lack research backing.

The items noted are sure to make some people unhappy. And, as with anything, there are going to be exceptions to what is stated. But, by in large, and whether you like it or not, the evidence does not support these therapies.

The Johnson Intervention
This is an old intervention. Initially was designed to supportively confront problem drinkers by family and friends, it sometimes had a ruse element — i.e., the intended client was told one thing and then confronted by a room full of people. The process was meant to cut through a person’s denial, motivate that person, and get that person into treatment as soon as possible (Johnson, 1986). It served many addiction counselors as an intervention for years. Early reports touted this intervention as being highly successful. Later, however, rigorous research does not support those claims. In fact, one study found a high relapse rate associated with this procedure (Loneck, Garret, & Banks, 1996). Given the later research findings, the Johnson Intervention is seen well intended, but empirically unsupported.

Catharsis
A string of therapies often used by addiction counselors promotes, encourages, and even demands that clients ventilate their feelings in order to correct problems (Thaler & Lalich, 1996). Certainly, clients with an addiction have experienced more than their share of negative emotions. Some use substances to cope with such emotions. To address these types of client behaviors, it sort of makes sense that one way to cope with negative emotions is to let it all out. The belief is that easing the internal emotional pressure will help things along.

Such strategies run the gambit from Primal Therapy that promotes literally screaming out pain and neurosis, to anger therapy that promotes expressing anger in order to alleviate it. In the latter case, we have all heard of sessions where clients were encouraged to yell, beat something, or engage in other aggressive acts to relieve the pressure of anger.

The research does not support these or similar strategies. For one thing, ventilating feelings (catharsis) is not in and of itself curative. The theories behind these grew out of outmoded ideas of how the mind works. Such theories were simple and inaccurate then, and remain so.

What we do know, for example, is that encouraging anger in a session(s) actually encourages more anger. Simply, it does the opposite of what it is intended to do. Moreover, if these forms of therapy are taken too far, they can result in emotional instability and heighten problems (Thaler & Lalich, 1996).

Repressed memory
It was all the rage in the late ‘80s and early ‘90s, this repressed memory thing. Along the same lines as catharsis, it was based on the idea that some negative feelings are repressed. In order to get over those feelings, they had to be retrieved and expressed. In our field, some have argued that those with an addiction have or repress pain by using various chemicals. So, in order to get better, the counselor sets the stage for the client to go back and relive those feelings that are causing problems now. Once retrieved and expressed, the client is supposed to improve — a good common sense idea, but one fraught with problems (Thaler & Lalich, 1996; Lynn, Lock, Loftus, Krackow, & Lilienfeld, 2003).
One of the more significant problems with repressed memory forms of therapy centers on the idea that our memories are somehow forever and clearly stored in our brains. This is not the case. We do not perfectly store all our memories. Rather memories are always seen through panes of other memories. And memories are constantly being made and modified. So if the retrieval process is supposed to bring back clear memories, it doesn’t. It brings back, at best, a muddled and distorted set of memories.

The second problem with repressed memory arises from this: if a counselor is searching for a particular memory they can press a certain line of questions and suppositions, which can lead the client to believe the some distant event occurred when in fact it didn’t.
This is not to say that you don’t have good solid memories. You do. Yet, research has show they are not as crisp as some would have you believe, and they are prone to manipulation (Thaler & Lalich, 1996; Lynn, Lock, Loftus, Krackow, & Lilienfeld, 2003).
As some of you recall, this “repressed memory thing” brought a number of people to trial and eventually to prison. Then there were the eventual counter suits. And, a number of those who practiced repressed memory techniques were in turn sent to prison, or forced to pay restitution. In this day and age of litigation, I would voice caution to anyone who is doing this form of therapy. And if you do decide to do it, make sure you have corroborating evidence.

A myriad of unsupported therapies
We would not want to end without listing other types of therapies that go a little farther out on the unsubstantiated research limb. Here is a short list:

• Channeling
• Color therapy
• Crystal healings
• Tarot readings
• Aromatherapy
• Rebirthing
• Spirit releasing
• And believe it or not, hot tubbing.

The “try it yourself” section
Some readers still might feel unconvinced that certain interventions mentioned above are unsubstantiated.

To add substance to your claim, you will need to conduct a field experiment that would ideally compare three matched groups. One group would have no treatment given it, one group would have a research-based treatment administered to it (see previous columns), and one group would receive one of the above therapies.

Should one of the therapies mentioned in this column produce better results, I would love to see that paper. And, if the experiment was repeated and still produced the same results, I will be prepared to eat crow.

Michael J. Taleff, PhD, CSAC, MAC, is the Coordinator of the Center for Substance Abuse for the University of Hawai’i at Manoa. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
Johnson, V.E. (1986). Interventions: How to help someone who doesn’t want help. Minneapolis, MN: Johnson Institute Books.
Loneck, B., Garret, S.A., & Banks, M. (1996). The Johnson intervention and relapse during outpatient treatment. American Journal of Drug & Alcohol Abuse. 22, 363-365.
Lynn, S.J., Lock, T., Loftus, E.F., Krackow, E., & Lilienfeld, S.0. (2003). The remembrance of things past: Problematic memory recovery techniques in psychotherapy. In S.O. Lilienfeld, S.J. Lynn, & J.M. Lohr (Eds.). Science and pseudoscience in clinical psychology (pp. 205-339). New York: Guilford.
MacKillop, J., Lisman, S.A., Weinstein, A., & Rosenbaum, D. (2003). Controversial treatments for alcoholism. In S.O. Lilienfeld, S.J. Lynn, & J.M. Lohr (Eds.). Science and pseudoscience in clinical psychology (pp. 273-305). New York: Guilford.
Roth, A. & Fonagy, P. (1996). What works for whom: A critical review of psychotherapy research. New York: Guilford.
Thaler, M. & Lalich, J. (1996). Crazy therapies: What are they? Do they work? San Francisco: Jossey-Bass.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2004, v.5, n.5, pp. 46-47.

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