Abstract

Harm reduction psychotherapy (HRP) is an approach to providing psychotherapy to people who use substances in which abstinence is considered neither a prerequisite to treatment nor its predominant mark of success. There is to date scant empirical research on this clinical approach despite its decades-long practice. Our study aims to spur further investigations by asking: 1) what are the basic building blocks of HRP; and (2) what theory might explain how its core strategies are unified? Eight leading HRP proponents and practitioners participated in semi-structured interviews to explore the nature of their work and how they came to it. Through an analysis of the interviews guided by grounded theory, we propose an explanatory model of HRP as practiced in the U.S. In this model, practitioners, informed by an ethos of defiant hospitality, deploy a variety of therapeutic processes whose combined, complex effects are captured in the phrase making room, which conveys opening up space while simultaneously providing safe enclosure. Making room is operationalized in processes comprising: inviting, meeting at, staying with, holding, reframing substance use, leveraging change from within, supporting agency, and signaling the limits. We discuss the model as deeply informed by its socio-historical roots within treatment spaces that participants experienced as failing to meet their clients' needs. We also consider HRP's implications for expanding the reach and capacity of addiction care for the majority of individuals with substance use disorders who may initially be unwilling or unable to abstain. Lastly, we describe its potential for furthering the field's understanding of therapeutic practice with marginalized populations.

摘要

减少危害心理治疗 (HRP) 是一种为使用戒断既不是治疗的先决条件也不是治疗成功的主要标志的物质的人提供心理治疗的方法。尽管这种临床方法已有数十年的实践，但迄今为止对这种临床方法的实证研究很少。我们的研究旨在通过询问以下问题来激发进一步的调查：1) HRP 的基本组成部分是什么；(2) 什么理论可以解释其核心战略是如何统一的？八位领先的 HRP 支持者和从业者参加了半结构化访谈，以探讨他们的工作性质以及他们是如何从事这项工作的。通过对扎根理论指导下的访谈的分析，我们提出了一个在美国实践的 HRP 解释模型。挑衅的款待，部署各种治疗过程，这些过程的组合、复杂的效果在短语制作室中被捕捉到，它传达了开放空间，同时提供了安全的封闭空间。腾出空间在包括以下过程的过程中运作：邀请、会议、停留、保持、重新规划物质使用、利用内部变化、支持机构和发出限制信号. 我们讨论了该模型，因为其在治疗空间中的社会历史根源深深地了解了参与者在未能满足客户需求时所经历的情况。我们还考虑了 HRP 对扩大大多数最初可能不愿意或无法戒烟的物质使用障碍患者的成瘾护理范围和能力的影响。最后，我们描述了它在促进该领域对边缘化人群治疗实践的理解方面的潜力。