Expose AA

It's about time someone told you the truth about Alcoholics Anonymous

Dr. Tiebout on character traits and therapy for alcoholics.

Dr. Harry Tiebout’s psychoanalytic observations in the 1940s and 1950s on alcoholics and their recovery process the stage for confrontational therapies in the treatment of alcoholism. Tiebout contended that alcoholism was rooted in character malformation that consisted of ego inflation (narcissism, grandiosity, dishonesty); self-encapsulation (disconnection from and suspiciousness of others); inner tension and hostility (guilt, anger, resentment); and a preoccupation with power and control (resistance to external influence, defiant individuality). The alcoholic, in his view, was incapable of accurate self-perception due to an elaborate system of defense mechanisms (e.g., denial, projection of blame) that simultaneously justified drinking and buttressed self-esteem. Tiebout believed that this defense structure became entrenched over the long course of alcoholism until the alcoholic hit bottom and experienced full surrender (conversion) — a disciplining process that produced deflation of the infantile ego, self-acceptance, humility and inner peace.

The task of the professional helper, according to Tiebout, was to move the alcoholic from superficial verbal compliance (and behavioral defiance) into and through a process of surrender, personality reconstruction and the development of a disciplined way of life — an early source of the aphorism, “Break ‘em down to build ‘em up.” Tiebout’s influence was significant due to his close association with Alcoholics Anonymous (AA), the widespread dissemination of his writings, and his prominence as a speaker at professional alcoholism conferences. He suggested that therapists could hasten the alcoholic’s recovery process by puncturing narcissistic encapsulation, confronting faulty reasoning processes, inducing a surrender experience and facilitating reconstruction of personal identity and relationships.

Without the legitimizing theoretical foundation laid by Kolb, Tiebout and others, the emergence of harsh confrontation techniques in the late 1950s and 1960s might have been viewed as countertransference run amok, and gross violation of professional ethics. Instead, it came to be viewed as a necessary approach to treatment, “the only language they can understand.” Therapeutic confrontation was essentially founded on four interrelated assumptions (Bassin, 1975).

1) Addiction is rooted in an immature, defective character encased within an armor-plated defense structure. Indeed, in DSM-II alcoholism and drug dependence were classified as personality disorders. Vernon Johnson (1973) opined that “the alcoholic evades or denies outright any need for help whenever he is approached. It must be remembered that he is not in touch with reality.”

2) The seemingly passive methods of traditional psychotherapies are hopelessly ineffective in penetrating this defensive structure and altering deformity of character.

3) The addict/alcoholic can therefore be reached only by a “dynamite charge” that breaks through this protective shield.

4) Verbal confrontation is the most effective means of engaging and changing addictive behavior.
Following its introduction in addiction treatment, there was some short-lived exploration of broader uses of confrontational therapies in the United States “to separate what a man is from what he seems to be, states himself to be, or would have us believe he is” (Weisman, 1973).