A group of 5 researchers completed the first study of Harm Reduction Psychotherapy (HRP)in 2021. Their goal – to identify the therapeutic techniques of harm reduction therapy so that future research on what helps people who use drugs has a consistent basis of study.

The group interviewed 8 pioneering practitioners in the U.S., including HRTC’s founders. For those of you who know about these things, they used a grounded theory approach and conducted semi-structured interviews. They summarized their results as follows

The data revealed a core therapeutic ethos, anchored in HRP’s historical and social context: defiant hospitality. What we usually call RADICAL hospitality they called DEFIANT because welcoming people who actively use drugs into treatment is an act of defiance in the context of the War on Drugs and abstinence-driven treatment. Supporting this ethos is the creation of a therapeutic environment that provides both enclosure and safety on the one hand, and room for exploration and growth on the other

Article Abstract

Harm reduction psychotherapy (HRP) is an approach to providing psychotherapy to people who use substances in which abstinence is considered neither a prerequisite to treatment nor its predominant mark of success. There is to date scant empirical research on this clinical approach despite its decades-long practice. Our study aims to spur further investigations by asking: 1) what are the basic building blocks of HRP; and (2) what theory might explain how its core strategies are unified?

Eight leading HRP proponents and practitioners participated in semi-structured interviews to explore the nature of their work and how they came to it. Through an analysis of the interviews guided by grounded theory, we propose an explanatory model of HRP as practiced in the U.S. In this model, practitioners, informed by an ethos of defiant hospitality, deploy a variety of therapeutic processes whose combined, complex effects are captured in the phrase making room, which conveys opening up space while simultaneously providing safe enclosure. Making room is operationalized in processes comprising: inviting, meeting at, staying with, holding, reframing substance use, leveraging change from within, supporting agency, and signaling the limits. We discuss the model as deeply informed by its socio-historical roots within treatment spaces that participants experienced as failing to meet their clients’ needs. We also consider HRP’s implications for expanding the reach and capacity of addiction care for the majority of individuals with substance use disorders who may initially be unwilling or unable to abstain. Lastly, we describe its potential for furthering the field’s understanding of therapeutic practice with marginalized populations.

https://www.tandfonline.com/doi/abs/10.1080/16066359.2021.1900129?journalCode=iart20