Empathy and substance abuse counseling

Empathy in substance abuse counseling is well documented. But how can you use empathy in the context of varying viewpoints? Licensed clinical social worker and drug/alcohol counselor Kenneth Pecoraro elucidates here.

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Learning empathy requires trying to imagine and understand other’s viewpoints and experiences, that can bring with it some distinct challenges and obstacles. One obstacle that is often overlooked is the importance of recognizing that you can empathize with another person’s situation or viewpoint that you personally disagree with.

So, how do you practice empathizing in the context of substance abuse counseling for addiction? We explore here. Then, we invite your questions at the end.

Empathy: A practice for counselor AND addict

At this point, the importance of empathy in substance abuse counseling, (actually in all types of counseling) is well documented. It is essentially impossible to effectively help someone else who may have a substance abuse problem or mental health issue without being able to demonstrate a reasonable understanding of some of the thoughts, feelings, struggles and other challenges involved in the recovery process.

At the same time, someone seeking help for their own substance abuse issue also benefits from learning to display empathy. Addiction can so often be associated with a self-serving “me first” attitude especially in its advanced later stages, therefore learning to understand, care about and display empathy toward another’s feelings and frame of reference can once again be a critical part of the healing process when learning to live without the substance.

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Empathy without Agreement

In today’s world of substance abuse there are so many heated debates about various viewpoints. Recovery has become much more individualized. Therefore, people’s personal outlook on the change process, right or wrong, is an integral part of the equation. But when learning empathy, the thought that, “If I try to understand another’s opposing viewpoint, I am therefore saying that I agree with it or condone it,” can halt the empathy process like a brick wall in the middle of the road. So how can you reconcile differing views?

“Empathy without Agreement” – or the ability to allow oneself to understand a viewpoint that one does not agree with, is a critical factor when it comes to moving past these debates.

Consider an example:

Tom age 19, says “There is nothing at all wrong with me smoking marijuana regularly, as long as I am not using hard drugs like heroin and crack I will be fine.” But his father, who himself is a long time recovering addict says, “A drug is a drug and if you’re getting high, eventually you’ll experience worsening consequences.”

Analysis: Forgetting about who may be right or wrong for a second, for these two individuals to be able to move forward it would be important to try to practice “Empathy without Agreement.” There are many people in the world who agree with Tom’s viewpoint, and there are many others who would side with his father. However, to effectively practice Empathy without Agreement, one has to let go of the idea that if they try to understand the opposing viewpoint, that means that they are condoning it. In this example, Empathy without Agreement would play out something like this:

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Tom – (Empathizing with Dad even though he does not agree with him) – “I understand that my father worries that my marijuana smoking will one day progress to harder drugs because he is concerned about what is best for me and he wants me to be a success in life. I disagree and think that I am going to be a success anyway regardless if I smoke marijuana because I still did well in school despite my marijuana use. But I do realize that he is just trying to look out for me because he cares.”

Father – Practicing Empathy without Agreement – “I was young once, and I remember what it was like to feel invincible and to want to have a good time and to think that I could party without things getting worse. I realize that Tom believes that as long as he is going to school and he isn’t getting arrested he is going to be fine. I disagree and think he is making a mistake but I do realize that he simply does not believe there is a chance things could get worse.”

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The goal is to facilitate healthy dialogue

Please do not miss the point being made here. This is not at all about whose viewpoint is the right one in the above example. Eventually, in Tom’s case, time would tell who was correct. The critical point here is that by practicing Empathy without Agreement, Tom and his father are increasing the likelihood of maintaining a productive and constructive dialogue with one another without constantly butting heads because each side refuses to try to see the other’s viewpoint.

In just about any disagreement, empathy can be like a bridge between opposing islands. It can be difficult and challenging to cross that bridge, however, nonetheless by trying to understand others whom we do not agree with is a much needed starting point in keeping those vital lines of communication open. Where there is communication, there is still hope in any dispute. Therefore, in any potentially heated dispute, learning to practice and display Empathy without Agreement is an essential tool for all involved.

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About the author
Kenneth Pecoraro, LCSW, LCADC, CCS has worked directly providing treatment for individuals with substance use and coexisting emotional-behavioral issues for over 20 years using a motivational, skills and strengths based, individualized client-centered perspective. The techniques explained in his method, Taking the Escalator: An Alternative to the 12 Steps, help individuals who are resistant to traditional approaches gain the tools needed for learning to increase insight and motivation for positive change.


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  1. Ken, here is my 3 cents on this important issue.
    LISTENING/RECEIVING with an understanding that having your own opinion is healthy and assertive.
    Clinical work has progressed over the last 10 years, as the methods of treatment have progressed to show this type of understanding.
    Old school stuff was always one way ! I experienced this type of attitude while I helped to construct a business complex on the Embarcadero (SF). The ‘residents’ were all told what to do, I saw no room for personal growth. That was twenty years ago. . . I let go when I left.

  2. This is a terrific article, Kenneth! Practicing empathy, even in the absence of agreement, is something I continue to work on. Although I am aware of the necessity of the practice and of the positve benefits the practive has, I can still struggle with it at times.

    Letting go of my ego is a tough thing to do. Being resolute in my convictions and beliefs has always been much easier.

    Recently, I get all bent out of shape about things that I often hear in different environments with other people who are living a life in recovery or are trying to. Without getting into it here (and you know enough about me to assume correctly that I could go on at length about the matter) I can now say that practicing empathy has allowed me to lean back, take a breath, listen, and relate. I don’t have to agree with all the information I am presented with, but accepting that other people can hold a differing point of view has proven to be a healthy endeavor for me.

    This was a good read for me, Kenneth. Keep it up, man. You do good work.

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