Attachment theory as a working model for the therapist transitioning from early to later recovery substance abuse treatment

Psychotherapy with addicted individuals often involves a shift in therapeutic techniques during the transition from early to later recovery treatment. A conceptual model based in attachment theory can provide a rationale and framework for this shift in the treatment of some addicted persons. Techniques and case material are presented to illustrate how a therapist first ''establishes a secure base'' and then transitions to ''facilitating exploration.'' An active, directive, supportive, and educative therapeutic approach that deemphasizes exploratory work in early recovery helps the patient achieve abstinence and develop a sense of security and attachment with the therapist. This sense of therapeutic security combined with ongoing abstinence permits a shift to a more nondirective, expressive therapeutic stance that facilitates the exploratory work of later recovery. Working through these issues in the therapeutic transition provides an excellent opportunity to examine the interpersonal and emotional difficulties of addicted patients. Two cases are presented to illustrate a successful and unsuccessful attempt to establish a secure base and facilitate exploration in substance abuse psychotherapy.