“Carefrontation” Offers a More Compassionate Route to Healing Addiction
and Restoring Health to the Patient and the Family
Renowned New York Psychotherapist Harris Stratyner, Ph.D., advocates “Carefrontation”
as an effective and important alternative to traditional addiction eradication therapies.
NEW YORK ….The era of confrontational therapy to treat substance abusers is over. Abuse, mockery, guilt, shame, torment and emotional flagellation only serve to exacerbate the underlying issues of addiction. They simply don’t work. There is a renaissance of sorts under way in the field of treating the addicted personality, and at its core lies the concept of “Carefrontation,” which, as one might surmise, is the antithesis of confrontation. Renowned psychotherapist Harris Stratyner, Ph.D., CASAC, not only coined the “Carefrontation” term — he is the standard-bearer of its core values and a champion of its effectiveness in treating those afflicted with chemical dependency.
“In this field what you find is a great deal of confrontation in treating patients,” Dr. Stratyner explains. A respected clinician, Dr. Stratyner is a Clinical Associate Professor at the Mount Sinai School of Medicine, in New York City, a Vice Chair of the National Council on Alcoholism and Drug Dependence (NCADD) Board of Directors and a mental health treatment specialist with nearly three decades of experience treating the addictive personality. Dr. Stratyner is convinced that taking a kinder, gentler approach is the surest way to reach the soul of the addictive personality, explore its causes, and set a course for effective, lasting treatment.
“Many people who have psychiatric illnesses cannot tolerate a strong confrontational approach,” Dr. Stratyner says. “Instead, we need to treat these people with dignity and respect, while still holding that person accountable and responsible for their lives.” Carefrontation combines the latest motivational engagement techniques with an environment that fosters the dignity and respect that are the foundation for self-esteem, communication and healing. This technique allows patients to acknowledge that they own their illness and must take steps to responsibly deal with its ramifications.
Dr. Stratyner is viewed among his colleagues and patients as a trailblazer in conceiving the technique of Carefontation and integrating it into the therapeutic environment. Dr. Stratyner also co-edited the Physician’s Desk Reference for Pediatric and Adolescent Mental Health.
“Carefrontation as a concept is not unlike treating a diabetic — the patient has to acknowledge that he or she has diabetes, while making sure they know that they still have to check their blood sugar, watch their diet, etc.,” Dr. Stratyner explains. Owning the illness and realizing that the patient is inherently responsible for their own treatment are crucial to making progress in treatment.
“In addition, I see a lot of blaming going on,” Dr. Stratyner adds. “Addiction is a disease, primarily: it’s progressive, and it’s fatal.” When the subject is addiction, “people tend to make a moral judgment,” Dr. Stratyner states. “They get angry,” and those suffering from addiction are frequently relegated to neglect, or society deems them high risks and sends them off to be incarcerated. “Our prisons are filled with people who have addiction problems,” he observes. Treating the affliction as a disease rather than a moral infraction or personal shortcoming is a major step toward confronting reality and commencing valuable treatment.
Confrontation, Dr. Stratyner believes, negatively impacts the client-patient relationship, and diminishes the chances for long-term growth and liberation from addictive substances. Carefrontation, on the other hand, interweaves compassion, empathy and understanding into the therapeutic setting and builds mutual trust. “The whole thrust is engagement,” Dr. Stratyner says. “It’s so important to develop a therapeutic alliance. You always want to give the patient a place to stand. And you never want to back the patient into a corner; that’s when they bite.”
Patients who feel emotionally threatened or who are put on the defensive are apt to lapse into their old ways, Dr. Stratyner points out. The rate of recidivism among these patients is high. Giving the patient space to explore their emotions and share their feelings in a non-confrontational way reaps vastly improved rewards over aggressive therapeutic methods. This is not to say that some patients don’t need to be dealt with more firmly. “Sometimes I use stronger Carefrontation: ‘Listen, this is what’s going on, and it needs to be addressed now.’” And if a patient is genetically predisposed to addiction, there is no alternative but complete abstinence. “’You absolutely can’t drink,’ I tell them. So total abstinence is the rule, and I will work with you all the way.”
Moderation management, or allowing patients to indulge in their chemical of choice to a certain degree, does not align with the Carefrontation technique, Dr. Stratyner insists. “It simply doesn’t work.” Abstinence rules in every case, and is important in the path toward complete sobriety. He stresses that he never rules out ancillary treatment in helping a patient to overcome addiction. “You can’t rule out any kind of treatment,” he says. “Just because you have an addiction doesn’t mean you should rule out a mood stabilizer or medicine” that can help a patient through the therapeutic process.
Dr. Stratyner explains that he has had many positive influences in his life, but few have reached the impact of the advice given to him by his godfather, the jazz genius John Birks “Dizzy” Gillespie. “He had a tremendous influence on my life,” Dr. Stratyner says. “He always taught me to treat people with dignity and respect.” This unselfish approach to treating people was the progenitor of the Carefontation technique that has helped so many patients, Dr. Stratyner reveals.
Dr. Stratyner acknowledges that patients are human beings; he does his best to interject a heavy dose of humor into the therapeutic setting when appropriate. “I try to get people to look at the good in every person,” he says. “The key is to try to be a good guy and not be a schmuck. Don’t shame people; treat them with respect.”
In addition to his private practice, Dr. Stratyner hosts a radio program entitled “Here’s to Your Good Health” on WFAS AM 1230 in Westchester County, a program he developed and has hosted for 24 years.
About Harris Stratyner Ph.D.
Dr. Stratyner who has offices on the Upper East Side in Manhattan and in Yonkers in Westchester County is also a Clinical Associate Professor at the Mount Sinai School of Medicine. He is a contributing author to the PDR Guide to Pediatric & Adolescent Mental Health. Dr. Stratyner developed the technique “Carefrontation,” which is a treatment approach for addicted individuals and people with co-occurring disorders that advocates for treating every patient with respect and dignity–no shaming or blaming–but does hold people responsible for dealing with one’s own addiction or mental health condition.
