Harm Reduction is an approach to counseling that emphasizes the importance of reducing harm in an individual’s life. It can also be considered a theory, orientation or philosophy, so there are several orientations or ways of doing therapy that incorporate harm reduction. I work with a lot of patients who haven’t learned how to take care of themselves very well. Using a lot of drugs, alcohol, eating disorders and self-mutilation all involve some deficit in being able to take care of oneself. However, it doesn’t help if everyone is just telling you to stop drinking or getting high or to just eat or stop cutting. Oftentimes, it makes people want to act out more. So having your therapist insist that in order for them to help you need to be clean and sober just doesn’t work. It’s even paradoxical or ironic. “If I knew how to control my drinking or to stop snorting Adderall and cocaine I wouldn’t need to come to you in the first place.” So a Harm Reduction approach acknowledges that a client is going to do what a client is going to do and there is not a whole lot that a therapist can do to make that person change unless the person is ready and motivated to change on his or her own.
Too often clients will go to a therapist who will tell them to stop using drugs and the client will just say, “See ya,” and never return. A Harm Reduction approach allows for therapist and client to continue to work together and to acknowledge the fact that it is up to the client to make decisions about health and harm but at the same time to actively pay attention to these issues with the support of a therapist. There are hundreds of examples of harm reduction in society these days. There is ample research to suggest needle exchange programs reduce HIV/AIDS, illness, crime etc… Many treatment programs now encourage patients to reduce the frequency of drug or alcohol use, the amount of use, the time someone is drinking or drugging and the strength of a substance. For example, a first attempt might be to limit drinking to weekends or to limit the amount of drinks to 4 or 5 over a long evening. That might seem like a lot to some, but it’s far better than drinking 18. Switching to beer from liquor is a harm reduction technique. Laying off the hard drugs and only drinking and smoking pot is a harm reduction technique. For many people, a harm reduction technique is the first step to the recognition that their behavior is having very real detrimental consequences. As a therapist, I hope that my patients will realize their behavior is interfering in their ability to get what they really want or need out of their lives, relationships, careers, etc… I also hope that they will eventually give abstinence a try. But you can’t work with a patient who doesn’t want to come to therapy and insisting on abstinence doesn’t work. Times have changed from when treatment programs kicked people out for getting high twice during treatment. If you’ve read this far into this subject, then you are ready for most therapists favorite joke: How many therapists does it take to change a light bulb…? One, but the light bulb has to want to change. This captures the Harm Reduction model and the importance of clients recognizing and understanding their intrinsic motivation to make changes in their lives.