Every attempt has been made in previous chapters of this book to present a perspective which avoids an idealized view of the therapeutic process as an operation smoothly and inevitably moving forward to success, as each patient responds to our wise and well-planned interventions. This chapter seeks further to correct any such caricature, and considers some problematic workaday situations.

Going wrong

People who wish to treat alcohol problems must develop an appreciation of the ways in which treatment can go wrong. They must train their eyes quickly to recognize these situations, and must be aware of the familiar patterns of events against which to interpret the latest instance of something going wrong. They must learn to examine the extent to which the therapist is going wrong, and the extent to which it is the patient, and most particularly to analyse what is amiss in the interaction. They must learn not to be discouraged or defeated by such events, but to turn them so far as possible to good therapeutic advantage. One cannot treat alcohol dependence without things very often going wrong, and the essence of treatment is usually a series of trials and errors rather than a straight-line advance. Such a statement is not to be read as a licence for complacency. True, things will go wrong and we must not be too flustered by that fact, but equally true is the insistence that the situation must be recognized and an effort made to put it right.