Harm reduction is a philosophy and set of interventions that seek to reduce the harmful consequences of substance use and other risky behaviors without requiring abstinence (Marlatt, 1998). Integrative harm reduction psychotherapy is based on the assumption that substance abuse and other potentially risky behavior are best understood in the context of the whole person in his or her sociocultural context and has the goals of identifying the psychological, biological, and social currents that contribute to the addictive process, clarifying the multiple meanings of the substance abuse, and individually tailoring psychotherapy to the unique needs of each patient.
The therapy draws on the contributions of the psychodynamic, cognitive-behavioral, humanistic, and biological traditions to address the unique vulnerabilities and consequences related to each patient’s substance use. The abandonment of the abstinence requirement enables the therapy to begin with whatever brings the patient for help. The form, focus, and timing of interventions must emerge out of the ongoing therapeutic dialogue and negotiation between therapist and patient. This places the relationship and collaborative nature of the work at the forefront of the therapy. A good therapeutic relationship facilitates the other therapeutic activities: skills building and active strategizing to support positive changes in substance use, exploration of the multiple personal and social meanings of problem substance use, and the discovery of new, more effective solutions to related vulnerability factors. These broad focuses are addressed in seven therapeutic tasks: managing the therapeutic alliance; the therapeutic relationship heals; strengthening self-management skills for change; assessment as treatment; embracing ambivalence; harm reduction goal setting; and active strategies for positive change.
(excerpted from Tartarsky and Kellogg (JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 66(2), 123–135, 2010)