Psychology and Treatment of Alcoholism

Abstract
Based on a study of some 250 alcoholic patients, a concept is introduced of a barrier or shell surrounding the inner Self of alcoholics which obstructs free interchange between the world of the Self and the outer world. Support for this concept is derived from (1) a study of release phenomena appearing during the course of sprees, (2) remarks and dreams of patients, and (3) a peculiar clinical phenomenon which produces in patients the sensation of being exposed. In the strategy of treatment the therapist must remain constantly alert to the existence of this barrier and focus his initial attention upon its penetration in order to establish a working relationship be- tween therapist and the patient''s feelings. Throughout treatment the therapist must face possible interruption of this relationship because for one reason or another the barrier has closed off again. Watching the barrier, the therapist is guided by 3 basic principles in technique: (1) The patient must suffer or feel anxiety about himself and his condition. (2) It is the impersonal pressures of reality which activate suffering. (3) The therapist''s first and immediate task is tc overcome the patient''s refusal, unwillingness or inability to sense these pressures of reality. A case illustrating application of these principles is presented.