University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations 1896 - February 2014 1-1-1981 Counseling the abstaining alcoholic. Charles Travers Harrell University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_1 Recommended Citation Harrell, Charles Travers, "Counseling the abstaining alcoholic." (1981). Doctoral Dissertations 1896 - February 2014. 3673. https://scholarworks.umass.edu/dissertations_1/3673 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations 1896 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. COUNSELING THE ABSTAINING ALCOHOLIC Dissertation Presented By CHARLES TRAVERS HARRELL Submi tl'- J to the Graduate Scliool of the University of Massachusetts in partial f ulf i lliTient of the requirements for the degree of DOCTOR OF EDUCATION September 1931 School of Education © Charles T. Harrell 1981 All Rights Reserved ABSTRACT Counseling the Abstaining Alcoholic (September 1981) Charles Travers Harrell, A.B. , University of Michigan M.A,, University of Michigan Ed.D., University of Massachusetts Directed by; Professor John Wideman A presentation of a counseling approach, introduc- ing the concept of "Third Person." The conclusions and recommendations to counselors of abstaining alcoholics who have attained and sustained without interruption a period of alcohol abstinence is based upon an original report covering the period of 1973-1979 of the responses of one hundred thirty-seven self -admitted alcoholics. An examination of the scope of alcoholism on a na- tional, state and local level is presented followed by an examination of the various views of professionals, academic and social, of the nature of the problem of alcoholism with attention given to misconceptions main- tained by the general public. A discussion of the characteristics of the alco- holic person is presented which is primarily based upon data obtained from interviews from the sample. Atten- IV tion is directed to the inner world of the alcoholic, '' the '' Inscape. Possible solutions to the problem and a brief dis- cussion of some current modes of treatment of alcoholism are presented with comment as to the limitations and efficacy of the modes. Considerable attention and cri- tique is given to the program of Alcoholics Anonymous. An examination of a humanistic, existential, client -centered approach to counseling the abstaining alcoholic is detailed with the introduction of the "Third Person" concept as a phenomena that results from the successful application of this approach. Client-counselor relationships are discussed with special attention given to the presence of empathy, pos- itive regard and congruence. Additional comments are made as to unrestricted honesty which must be maintained by the counselor. Frustration and fear as impelling characteristics of alcoholism and their resistance to being extinguished is discussed. A schema is presented based upon Maslow's schema for safety-risk. V The work concludes with a presentation of the at- titudinal and assumptive set necessary for the approach with recommendations to the counselor of the abstaining alcoholic as to its substance and practice. VI TABLE OF CONTENTS INTRODUCTION 1 Problems in Counseling the Alcoholic 2 Problems in Counseling the Abstaining Alcoholic 3 The Organization of the Material 5 The Scope of the Study 6 The Sample 8 Chapter I. SOME DIMENSIONS OF ALCOHOLISM IN THE UNITED STATES 12 Conclusions 41 II. ALCOHOLISM: WHAT DOES WHAT TO WHOM .... 44 What is Alcoholism? 44 Alcoholism and Allergy 60 Alcoholism and Psychological Causes ... 61 Alcoholism and Societal Considerations . 69 Alcoholism and Subjective Responses ... 77 Diagnosis of Alcoholism 81 Self-diagnosis 88 Conclusions 98 III. SOME CHARACTERISTICS OF THE ALCOHOLIC ... 100 Anxiety 109 Self-Esteem 114 Guilt 116 Grandiosity 118 Relations with Others 119 Paranoia 120 Depression 120 Polarized Emotions 120 Projection 121 Conclusions 121 IV. THE TREATMENT FOR THE ALCOHOLIC 123 Detoxification 124 Rehabilitation 128 Conclusions vii V. ALCOHOLICS ANONYMOUS 142 What is AA? AA Success and Uniqueness 149 Groups in AA Evaluating AA Counseling 155 Conclusions VI. SOME CONSIDERATIONS OF A HUMANISTIC, EXISTENTIAL, CLIENT-CENTERED APPROACH TO COUNSELING THE ABSTAINING ALCOHOLIC .... 176 The Thirty Day Period 177 The Thirty Day Requirement 177 Nutritive Aspects 191 Cultural Aspects 193 Frustration 201 Fear 204 Anxiety 214 Dislocation 214 Anger and Resentment 219 Polarities of Action 225 Cross-dependency 228 Sense of Re-birth 230 World-View 232 Other Feelings 235 Conclusions 240 VII. SPECIFIC DIMENSIONS OF A HUMANISTIC, EXISTENTIAL, CLIENT-CENTERED APPROACH TO COUNSELING THE ABSTAINING ALCOHOLIC . 242 Stage I 254 Stage II 263 Stages III and IV 272 Conclusions 276 VIII. THE THIRD PERSON 278 IX. THE ATTITUDINAL AND ASSUMPTIVE SET NECESSARY FOR THIS APPROACH 306 Religiosity and Religion 306 Cries for Help 323 Sins, Wrongs and Evil 330 God or "The Higher Power” 333 viii Ultimate Values 342 Right-Wrong; True-False; Good-Bad .... 342 The Third Force 344 X. COUNSELING THE COUNSELOR 360 CHAPTER NOTES 365 BIBLIOGRAPHY 371 IX LIST OF TABLES 1. The Sample and its Analysis 2 2. Hampden, Massachusetts, Elementary Schools Study 8 3. Emotional Feelings of Discomfiture 104 4. Self-Esteem 115 5. Step Five Effectiveness 171 6. Step Six Belief 172 7. Compulsion to Drink 182 X . INTRODUCTION This work is concerned with counseling the abstain- ing alcoholic and is limited in its purpose to consider- ation of the adjustment problems, problem presentations and the possible resolution of those problems. It is hoped that some insight and information for further inquiry can be stimulated which will be produc- tive for both the counselor and the client. Attention will be given tO/4!:he definitions of "alcoholism” A philosophical premise will be suggested from which the counselor may proceed. It is desired that the information can stimulate the counselor toward the de- termination of a model which can serve for effective support to the alcoholic in his attempts to adjust to problems generated by alcohol abuse and to those prob- lems which have been carried over from the pre-abuse period into the abstinence period. We are primarily concerned with the adjustment of the alcoholic to a life of sobriety, which requires total abstinence from the use of alcohol or substitutes for non-medical purposes. 1 2 Problems in Counseling the Alcoholic Attempts to counsel an alcoholic who is at the time of counseling using or abusing alcohol are fruitless. (1) The active alcoholic cannot conceptualize his problems nor is he capable of assorting them into a discrete arrangement for examination. (2) The alcoholic who is drinking is unable to distinguish between that which is "real'* and that which is "fantasy." (3) The active alcoholic is usually unable to dis- tinguish between his own individual problems and those which are assumed to be generated by people, places and things which are envi- ronmental. He is a victim of projection. (4) The denial mechanism is endemic to the active alcoholic who is unable to face the realities of drinking and the resultant damage which continues to be intensified by drinking. (5) The active alcoholic swings from one polarity of emotion to another. What seems to be a pressing problem at one time becomes lost in a maze of "new" problems. convinced that (6) The active alcoholic is usually he can control his drinking and that he can 3 exercise discretion as to what he drinks, the amount he drinks, and the effects of his drinking. (7) The active alcoholic is unaware of the devas- tating effects his dependency has upon him- self, his family, his friends, his occupation, and his community. (8) The active alcoholic will resist the concept of alcoholism viewing his maladaptive behavior as "accidental" or "usual" or "special." It is for these reasons which are plentifully doc- umented in the literature on alcoholism that counseling the abstaining alcoholic should be severely regimented until the client has been without the drug for a period of at least thrity days. Abstinence is the only goal for the counselor during the initial thirty day period. Problems in Counseling the Abstaining Alcoholic The alcoholic is an ill person. The nature of the illness, its diagnosis, treatment and prognosis will be discussed in the body of this work. The etiology is unknown. The illness is paradoxically simple and complex. If the client does not drink alcohol, he will not abuse it. If he does not abuse it, he will not become alco- 4 helically disabled. However, to the alcoholic, not drinking is a ter- rifying prospect and the process of establishing absti- nence is one that requires the intense concentration for the thirty day period. To repeat: the maintenance of abstinence is primary . it is vital to the exclusion of all other considerations. Without abstinence, help is at best severely inhibited and usually ineffective. Hence, we are not concerned with the attainment of abstinence; we are directing our effort ot the mainte - nance of abstinence and we are attempting to develop a counseling approach that will permit the client to con- front the array of problems he will face in daily liv- ing, problems which may have been generated prior to alcohol abuse, during abuse, or following the attainment of abstinence. There may be genetic or biological fac- tors involved, but for this work we are directing our main attention to those environmental and existential factors which contribute to his stress, anxiety and disorientation. Problems of the client can be roughly grouped into three prognostic opinions: (1) the problems can be eliminated; (2) the problems cannot be influenced; (3) the problems can be tolerated. This work attempts to give clarity to the difficul- 5 ties of the alcoholic client and eventually to lead the counselor to a humanistic, existential, client-centered approach to counseling which has given evidence of suc- cess in the counseling field.