Psychotherapy with Alcoholic Offenders

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Abstract
A pilot project of giving psychotherapy to 10 patients selected among offenders placed on probation by Detroit courts after sentence for offenses connected with drunkenness is described. Of the 10, 5 were compulsory patients, ordered to seek psychotherapy, and 5 voluntary patients, urged but not compelled by the probation officers to seek treatment. Their ages ranged between 25 and 40; half were married; half employed; most had character disorders. They had court records of 3 to 5 previous offenses and had been drinking heavily for 5 to 10 years. The patients were seen in once-a-week psychoanalytically oriented psychotherapy. Modifications in psycho-therapeutic technique were found to be necessary to involve these resistant, denial-prone patients in psychotherapy. Alterations in technique were largely in the direction of playing a more active, supportive therapeutic role. The therapists attempted to dissociate themselves from the court, assuring the patients that their clinic records would be confidential. The patient and his family were interviewed extensively by a social worker, he was examined psychiatri-cally and a battery of tests were administered by the psychologist. This experience aroused anxiety in the patient which was used as a lever to involve him in treatment. In the first therapeutic interview the patient was confronted with the results of the interviews and examinations, and with the evidence to show that he was an alcoholic and had underlying emotional conflicts. He was urged to become involved in treatment now, rather than in 10 years when the prognosis would not be so favorable. Major efforts were made to win the patient''s confidence and trust. The therapist actively demonstrated his being on the patient''s side by interceding for him with the court, and by visiting his home to interrupt a drinking bout. As the patient''s confidence in the therapist increased, a growth in mature, reality-oriented behavior was observed. The therapists cooperated closely with the probation officers who were used as "therapeutic assistants." Family therapy was vised extensively in all cases, spouses being seen in once-a-week psychotherapy. Environmental manipulation was found to be necessary. The involvement of relatives, employers and other professionals in a joint therapeutic effort was felt to be a key feature of the approach. While the role of compulsion in the treatment of these patients could not be fully evaluated it is suggested by preliminary impressions that the compelled patients became more involved in treatment than the voluntary. A conclusive evaluation of these therapeutic efforts is not possible, but the vast number of alcoholics who could be reached through the courts early in the course of their illness suggests the importance of increased attention to this group of patients.

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