Understanding and Counseling the Alcoholic by Howard J. Clinebell, Jr.
Howard J. Clinebell, Jr. Is Professor of Pastoral Counseling at the School of Theology at Claremont, California (1977). He is a member of the American Association of Marriage and Family Counselors, and the American Association of Pastoral Counselors. He is a licensed marriage, child and family counselor in the State of California. His personal website is http://members.aol.com/clinebellh/index.htm, and his email address is clinebellH@aol.com. This book is the Revised and Enlarged Edition published by Abingdon Press, Nashville, 10th Printing, 1990. Used by permission. This material ws prepared for Religion Online by Richard V. Kendall.
Chapter 13 -An Alcoholism Strategy for the Congregation
The spirit of the Lord is upon me . . . to proclaim release for prisoners and recovery of sight to the blind; to let the broken victims go free.
-- Luke 4:18 (NEB)
Those who are concerned about alcoholism and who also believe that the church has a significant role in the second half of the twentieth century long to see it take a more dynamic role in the solution of this gigantic problem. Local congregations, viewed collectively, represent a sleeping giant of influence and help to the burdened, so far as their potential contributions in this area are concerned. Many individual clergymen are providing valuable services in alcoholism education, working with local Councils on Alcoholism and helping alcoholics and their families. But most local churches, as total congregations, have hardly scratched the surface of their potential opportunity to be the "servant church" in the area of alcoholism.
The clergyman should set the tone of concern and help provide leadership for his churchís ministry in this area. His job is to catalyze interest, motivate key laymen, work with them to plan strategy and train a task force to implement it, and be available as a knowledgeable resource person. In the contemporary understanding of the church, ministering is a function of the entire congregation. The clergyman is a pastor of pastors, a teacher of teachers, a counselor of counselors. 1. His role is to inspire, train, coach, and work alongside the lay ministers who composed the congregation, in their ministering to persons in need (and to the needs of society through social and political action). This approach reflects a recovery of the New Testament understanding of the nature of the church and the Christian life. 2.
Every member of a congregation has a job to do in the healing-redemptive ministry of his church. It is his unique job -- only he can do it. Only as increasing numbers of us catch this vision and accept this challenge -- to be where the action is in the church -- can our congregations become redemptive communities, centers of help and healing. Only thus can they be gardens and hospitals, places of growth and healing, rather than museums.
`One of the challenges-to-service to which some members of every congregation should respond is the problem of alcoholism. Think of five and one-half million alcoholics and twenty million family members caught in a gigantic web of suffering. What an opportunity to make oneís life count in helping to meet human needs in the name of the Great Physician!
Implicit in the preceding chapters has been the belief that the minister and his congregation have many strategic opportunities in the area of alcoholism. The purpose of this final chapter is to discuss a five-pronged approach by which a local church can fulfill its opportunities and release its potentialities for good in this area. This chapter will be an overview of a plan and strategy for the church. As such, it will summarize some of the salient points in the chapters of Part III.
The five areas in which important contributions can be made by a congregation are: Education, prevention, community outreach, helping the alcoholic, and helping the family.
Alcoholism education aimed at developing a climate of understanding and acceptance. A church has an opportunity to help build the solid foundation of informed concern on which any effective approach to the problem must be based. Taken together, the churches and temples have the widest educational contact with adults of any institutions in our society. Over 121 million Americans belong to a church. Each week, forty or fifty million adults and many young people in the formative years listen to a spiritual leader speak on something which (hopefully) touches people where they live. Each week some three million teachers function in church programs of religious education for children, youth, and adults. Through these channels, the churches have an unrivaled opportunity to help develop understanding of alcoholism at the grass roots of our population. To take advantage of this opportunity, the churchís lay and ministerial leadership should plan and carry out a sustained, systematic educational effort to reach all ages from junior high up with the basic facts about alcoholism.
Education is concerned with aims, target groups, content, and methods. Choice of content and methods will be determined, to a large extent, by the aims or objectives of the educational program and the target groups one hopes to reach. In addition to its broad target -- reaching the entire congregation with a message that will help them understand alcoholism -- the church has a number of more limited and strategic target groups: teen-agers and pre-teens who are making or are about to make decisions about alcohol; parents who are searching for ways to prepare their children to cope constructively with alcohol and to avoid alcoholism; alcoholics and their families who need help but are afraid to come out of hiding (see Chapter 8). In addition, there are in nearly every congregation employers who have alcoholics in their businesses or plants, workers who know of untreated alcoholics in their unions, professional people with alcoholics among their clients or patients, public schoolteachers and opinion molders who through social prestige, political leadership, or involvement in the mass media help to create new images of public problems. By reaching target groups such as these with an enlightened view of alcoholism, church leaders can help key people in the community think, write, speak, and act more creatively on this problem.
Alcoholism education ought to be integrated into the churchís ongoing program of education on social problems in general, including other problems of alcohol and problems of mental health and illness. Whether oneís goal, so far as drinking is concerned, is abstinence or moderation, it is wise to approach education concerning alcoholism via the sickness conception and AA. Educationally these provide the best entrée to the interest of the average person. Nearly everyone, I have found, is interested in the dramatic story of AA, and this is a natural point of departure for a discussion of alcoholism. In this post-Prohibition era there are many people who are "allergic" to the usual temperance approach, but who will listen with rapt attention when alcoholism is presented as an illness to the danger of which one exposes oneís self when he drinks. Many young people find it almost impossible to conceive of taking a drink as a major moral issue, but they can readily understand the danger of getting a disease. Speakers from AA, Al-Anon, and Alateens often make an unforgettable impact on church groups by personalizing the problems and the recovery from alcoholism.
Whatever is taught about alcohol and alcoholism should be put in the context of a positive view of the good life as seen from the religious perspective. Emphasis should be placed on what the church is for rather than on what it is against. An important aspect of the unique contribution of a church is to provide a context for alcoholism education -- a view of life as a glad adventure and a gift from God. Within this frame of reference, decisions about all matters including alcoholism can be made, and an understanding of the congregationís mission to the burdened, including the alcoholic, can be gained.
Alcoholism education in churches, schools, and families should have two phases. The first has as its objective head-level understanding. Rigorously accurate presentation of the facts about alcoholism is the method of helping people move toward this objective. Information about the nature, causes, and treatments of alcoholism now available, plus an emphasis on the importance of knowing the warning signs of approaching addiction, are germaine to this phase. The new hope which now surrounds the problem should be highlighted, perhaps by describing the spiritually refreshing AA program and other treatment resources. The atmosphere of hopelessness which still attaches itself to "alcoholic" in the minds of many people is no longer appropriate to or in conformity with the treatability of the illness. Particular emphasis should be put on the inaccuracy of the Skid Row stereotype of "alcoholic," so far as the great majority of actual alcoholics are concerned. It is important, of course, to avoid oversimplifying the enigmatic complexities of the problem and to avoid painting an overoptimistic picture which ignores the dark realities and the unsolved problems which still exist in abundance.
Phase two of alcoholism education should move beyond head understanding to heart understanding of the persons suffering from the problem. This objective is much more difficult to achieve than the first. It involves modifying attitudes and feelings about alcoholics, increasing compassion toward them and their families, saying "yes" to them as persons of worth, whatever their problems in living. What is required is education in depth.
There are at least two things that seem to be crucial in changing attitudes. First, attitudes are changed in relationships and through experiencing something new that does not fit oneís old images and biases. One way of approaching this is to ask all the teachers in the church school to attend two open meetings of AA as a part of their preparation for teaching in the general area of alcohol and alcoholism. A schedule of nearby meetings should be provided with the suggestion that no more than two go to a given meeting. It should also be suggested that they stay after the meeting and get acquainted over coffee with some of the members. Person-to-person contacts with recovered and recovering alcoholics in AA have probably done more to lessen punitive attitudes toward alcoholics than any other influences. Such contacts will allow the teachers or pastoral care team members to discover that recovered alcoholics are not only people; they are frequently fine and likeable people.
The second thing about attitudinal change is that, although relatively little of it occurs in most formal educational procedures, it does take place spontaneously when people get involved in constructive action on a problem. Laymen should be encouraged to serve on local Councils on Alcoholism, work as volunteers in enlightened treatment facilities and halfway houses, both because such help is often needed and because the experiences will help to modify relationship-blocking stereotypes concerning alcoholics. A congregationís own program for alcoholics can be invaluable for the same two reasons. Somehow people who are to be effective in this area must be helped to get beyond their fears of alcoholics and their anger toward them, to a warm fellow-feeling which makes possible a joining of hands in mutual acceptance.
The basic attitudinal climate in a congregation with respect to alcoholism provides either a bridge or a barrier to its work with alcoholics and their families. If it is to be a bridge, so that the congregation can use its potential helping resources creatively, then somehow the hard lumps of judgmentalism which linger in our psyches, even when we wish they would go, will have to be melted by compassion. Only thus can a person become a channel of that acceptance of others which is the healing force in religion. The ultimate test of a churchís redemptive concern is its ability to accept the socially unacceptable, including the alcoholic.
The blocks to fuller acceptance of others are within the individual; they have to do with his lack of self-acceptance and his inability to accept Godís acceptance. In small personal growth and spiritual discovery groups, some laymen and pastors are discovering how to remove these inner blocks. They may discover, for instance, that it is because alcoholics and other social deviants threaten them psychologically that they become anxious and therefore hostile in their attempts to relate. Working through to a living experience of grace in group relationships can heal the inner alienation that keeps us alienated from others.
Some church people are troubled by the sickness conception of alcoholism, believing erroneously that it denies that there are ethical issues involved. Since the sickness conception is the only sound place to begin, in either prevention or therapy, this is a serious dilemma for them. Wrestling with the issues raised in Chapter 7 may help resolve this dilemma. It should be emphasized that to say that alcoholism is an illness does not necessarily imply that there are no ethical dimensions to the problem. An alcoholic is simply a person with a condition called alcoholism. His behavior, like yours and mine, is composed of a complex mixture of sin and sickness, compulsiveness and freedom, accountability and drivenness. The point is how one handles the ethical aspects of the problem. To moralize, as indicated earlier, is utterly futile. To treat the alcoholic as a person who has the capacity to become more responsible is close to the heart of both sound counseling and the AA approach. The point is that the sickness conception need not be seen as amoral in order to be an instrument of acceptance in the relationship.
There is a growing body of useful materials in the area of alcoholism education. 3. Sources of pamphlets, films, books, and teaching guides include local Councils on Alcoholism (or the National Council, 4, if there is no local affiliate), state alcoholism agencies, and denominational social problems agencies. An excellent, brief film for introducing a program or series is "To Your Health," produced for the World Health Organization.
. As indicated in the previous chapter, this is probably a churchís most important contribution in the struggle to conquer alcoholism. It is obvious that one of the chief channels of prevention is the program of alcoholism education. Prevention and education overlap, but they are not identical.
A congregation needs a strategy for prevention which is. a part of the larger strategy for preventing the broad spectrum of individual, family, and community problems. One of the mistakes that many churches have made in the past was to conceive of the prevention of alcohol problems on one level -- in terms of persuading people not to drink. The most important point in the last chapter was that the prevention of alcoholism can and should occur on several different levels simultaneously. Since prevention was discussed in detail in that chapter, the consideration here will be limited to illustrations of how a congregation can contribute to prevention on two of the four levels.
Prevention at the grass roots includes the whole range of activities in the program of a local church, which contribute to the development of wholeness in persons and the vitalizing of families so that they satisfy the basic interpersonal hungers of children, youth, and adults. A marital enrichment group, a family camp, a child-study group, a youth fellowship, a preparation for retirement group, a nursery program, a senior citizen club, premarital counseling, marriage counseling, pastoral care in bereavement, parent-child counseling, and the entire spiritual growth and educational thrust of the church -- all these are examples of resources which are designed to stimulate the growth of personality toward the realization of each individualís potentialities. To the extent that a church program succeeds in this, it helps to prevent alcoholism and other forms of personality illness at their source. The churchís role in presenting its message in pro-life ways, and in changing cultural attitudes such as moralism and success worship, is another contribution to grassroots prevention.
Prevention through influencing symptom selection is accomplished through alcoholism education which actually leads to either abstinence or the prevention of drunkenness. In a society in which a majority of adults not only use alcohol but attach considerable social significance to drinking, it is safe to assume that the majority of persons who are now children and youth will eventually decide to drink. Since this is the case, it is essential that a part of their preparation for living constructively in the adult world be to learn to distinguish responsible from irresponsible drinking. (The ethical distinctions, for example, between drinking as a part of a relaxed evening at home and drinking prior to operating a car or other piece of potentially lethal machinery, need to be seen clearly by a young person.) There are gradations of social responsibility and irresponsibility involved in a wide variety of drinking situations. With reference to the prevention of alcoholism, it is important to help young people see that the why of drinking is directly related to whether or not a person moves into problem drinking and that frequently intoxication or use of alcohol to cope with personality problems is dangerous and therefore irresponsible. It is at the point of failing to help youth develop ethical controls on the extent, occasion, and reasons for drinking that the one-track abstinence approach to alcohol education fails to prepare them for life in a society where the majority of them will probably drink.
The churchís role in prevention through early detection and treatment, and prevention through helping the children of alcoholics has been discussed adequately in the previous chapters.
Community outreach and leavening. The church that is isolated from the problems of its community (which extends from the local to the world community) is not being true to its mission to become the "light of the world" and the "salt of the earth." Ministers and laymen should see involvement in community alcoholism programs as an expression of their religious dedication. ĎWhat is needed is for churches to devise imaginative ways of getting more of the hundreds of thousands of dedicated laymen directly involved as trained volunteers in projects to deal with all kinds of personal and social problems, including alcoholism.
One of the encouraging aspects of the present picture is the amount of preventive educational work that is being done by individual ministers in their communities. The 146 Yale ministers had almost all been very active in this field. As we have said, five of them had helped to organize local Councils on Alcoholism. Another was engaged full time as the director of a state alcoholism program; still another reported that he was executive officer of a state "pilot experimental project" which included an information and rehabilitation center for alcoholism. Three respondents told of the following significant work on the community level:
1. Facilitated some friendly contacts between AA and a judge of the municipal court as well as the personnel manager of a large industrial firm.
2. Behind-the-scenes attempt to get the city welfare association to begin the educational approach to the problem in the community.
3. Tried to promote consideration of alcoholism as a public health problem with local council of social agencies and state council of social welfare.
Almost all the ministers reported giving talks on alcoholism to all manner of youth and adult groups in public schools, youth camps, AA groups, and various community organizations. Twelve had written one or more articles on alcoholism. The impressive contributions which this particular group of ministers is making in the educational and community leavening areas are evidences of what can and is being done. ĎWhat they are doing is but a small fragment of the total contribution of thousands of ministers over the country.
These men are convinced, for the most part, of the validity and importance of the scientific-therapeutic approach to alcoholism. They are rendering yeomanís service in helping to spread the kind of knowledge in their communities that will bring hidden alcoholics to help and lead gradually to the prevention of the disaster of alcoholism. It is hopeful that their number is increasing and that many of them are beginning to involve their laymen in this work.
Here are illustrations of what some churches are doing, usually through their social action committees, to implement an outreach ministry in alcoholism:
Many churches have invited AA, Al-Anon, and Alateen groups to use their fellowship halls. This is often a mutually enriching and enlightening experience, particularly if church members take the initiative in getting acquainted and expressing interest by occasionally attending open meetings, and by inviting speakers from these groups to address church groups.
Churchmen have worked with others to establish alcoholism inpatient and clinic facilities. A survey of clergymen conducted by Benson Y. Landis showed that a majority "expressed the opinion that the local church should help other community agencies establish special clinics to treat alcoholics." 5. Public clinics for alcoholics are right from the humanitarian and therapeutic standpoints. (They are also less expensive than the present "public care" system in which local governments spend millions each year on court, police, and jail facilities.)
Church members have helped establish local Councils on Alcoholism and have served as volunteers to "man" the information centers. Alcoholism is too big and complex a problem for any group to handle alone. Dedicated, knowledgeable churchmen have often seen the need to join forces with others in sparking a community-wide action program, coordinated by an Alcoholism Council.
Working to help open local hospitals to accept alcoholics as any other sick person is an important form of community outreach. It is particularly ironical when church-related hospitals have a policy (written or simply understood by the admissions staff) of not accepting alcoholics. Effective action can be taken by working through hospital boards.
Mobilizing moral support for state alcoholism programs is another way in which concerned churchmen can be an influence for good in this field. Unless public support is evident to state legislators, the programs may suffer from budgetary strangulation.
Many churches have had a role in backing alcohol education in public schools. The crucial issues are that it include alcoholism education and that it be sound in method and objective in content.
IV and V
Help for the alcoholic and his family. It is not valid to assume that, since there are now numerous specialized agencies engaged in alcoholism treatment, the church can properly relinquish all responsibility for direct services to alcoholics. For one thing, many alcoholics are not being reached in time with help by any of the community agencies. Alcoholics are very different and their treatment needs varied. An approach that suffices with one may not with another. Many require a combination of treatment resources to achieve recovery. For this reason, we need a diversity of approaches so that as many as possible may be helped. Equally important, the church has unique contributions which it can and should make to the helping process. Therefore, it is not appropriate to say, "Let AA and the local alcoholic clinic do the total job."
A church ought to support (with volunteer time, interest, and, if needed, money) the communityís alcoholic treatment programs and agencies. It should use them as often as appropriate to make referrals. Where needed community treatment resources are lacking, the clergyman and his lay leaders should help to spearhead efforts to provide them. But, at the same time, a church should be engaged in some one experimental approach by which it seeks to develop (1) ways of bringing a unique service to the helping o~ alcoholics and their families, and/or (2) new ways of reaching and motivating hidden alcoholics to accept help. Just what project a particular congregation should choose to do depends on the unmet needs of its community and the resources of the members who are available to help.
The following are examples of what various churches are doing. They are presented to suggest the wide variety of possibilities open to a congregation, possibilities limited only by the needs of the community and the resourcefulness of a churchís leaders.
An East coast church is sponsoring an experimental program in alcoholic rehabilitation for men on probation because of alcohol problems. The weekly meetings alternate between AA speakers and mental health or alcoholism education films. 6. A Southern California church sponsors "Sunday Night with Recovered Alcoholics" for these two purposes:
(1) To create an occasion and an atmosphere in which members of the clergy and other professional people may learn more about alcoholism and observe the recovered alcoholic through his own story. And, to give the recovered alcoholic a similar opportunity to listen to members of other disciplines who are interested and knowledgeable in the problem of alcoholism. (2) To give recovered alcoholics the means of better learning about the eleventh step, namely, "to seek through prayer and meditation to improve their conscious contact with God." 7.
Recovered alcoholics and professional people, in approximately equal numbers, are invited to these weekly meetings.
The Cleveland Center on Alcoholism has set up a series of afternoon discussion sessions at a church in a marginal economic area for wives of men with drinking problems. Since women from this particular area seldom come to the Center for help, it was decided to take the Center to them. The women could walk to this meeting place, which was in familiar surroundings, and their children could be left under supervision in the churchís recreation room. This is an illustration of a church cooperating with a community agency in a new pattern of service to families of alcoholics. There is no reason why a local church could not take the initiative in setting up a similar type of group, calling on whatever community resources are needed to provide the desired program.
On the West coast a halfway house for alcoholic men is sponsored cooperatively by several churches of one denomination. A church of another denomination, in the same area, is developing plans for a halfway house for alcoholic women. In such projects, it is important to train a group of laymen within the church for the various roles which they may fill.
A refreshing example of direct, congregational involvement in working with homeless alcoholics is a Church of the Brethren program. About a dozen congregations have "sponsored" alcoholics released from mental hospitals and prisons with no place to go. Sponsorship is similar to that accorded refugee families. The sponsors are responsible for helping the person find a job, obtain housing, and bear expenses until his first paycheck. A group within the congregations is trained to receive and relate to the alcoholic. Their assignment is to assist him in any way that may help him to adjust to living outside the institution. The educational impact of this program on the congregations -- in terms of their understanding of alcoholism and their acceptance of alcoholics -- has been a valuable by-product. A staff member from the office of Social Welfare of the denomination provides the preparatory training for the congregation, secures the alcoholic, and is available for follow-up guidance as problems arise. The first alcoholic to be sponsored by a congregation had four slips in that many years, but since then has had some eight years of complete sobriety. That one church has sponsored eleven other alcoholics. The most important thing a congregation must give a recovering alcoholic is a sense of acceptance in the fellowship. Such direct involvement in helping deeply troubled people forces a congregation to test the reality of its dedication to loving God and neighbor.
The use of personal growth groups as an aid in the spiritual development of recovered alcoholics was suggested in Chapter 10. Many of the depth Bible study, prayer fellowship, and koinonia groups which now function in many churches can serve alcoholics (and others) as means of stimulating growth which they desire in the vertical dimension of their lives. Frequently these groups are led by spiritually mature laymen who have had special training and preparation, including extensive small group experience.
The pastoral care team was mentioned in Chapter 11. This is a task force composed of those committed to pastoral care as their primary focus of lay ministry. Carefully selected and trained, this group works under the ministerís guidance, supplementing and broadening his work with the troubled. To help alcoholics effectively, the team should include stable AA and Al-Anon members of both sexes, and a physician who is acquainted with current medical approaches to the problem. The team should meet regularly for in-service training. Team members serve at the ministerís discretion, as "befrienders" 8. of those in crisis and those bearing heavy loads.
Organizing for Action
Alcoholism programs in local churches, which have been effective, seem to have gone through certain general steps:
1. Someone who is a "self-starter" and is concerned about alcoholism took the initiative. In some cases this was the minister. If a layman is the initiator, it is important for him to discuss the matter with the minister and get his support. Most clergymen are delighted when a layman takes active leadership in beginning such a project. The key point here is that in almost every case of a successful action project, one person started the ball rolling.
2. A group (usually small) was selected or recruited to share the responsibility. This can be an already-established committee on social action or a committee on alcohol problems. In some situations it is better for an ad hoc task force to be recruited to do a particular job. In any case, the responsible group must be brought in on the planning of the project as well as the implementation phase. Unless something of their thinking goes into the planning, it is probable that their motivation will be minimal.
3. The needs of the local situation were studied and a decision made by the responsible group concerning which unmet need should have top priority. In some cases, the minister or someone else had already decided what he felt needed to be done, and a group was invited to help in doing it. This may work, if the project has obvious merit and the group has some voice in deciding how it will be carried forward. But, in general, the earlier the working group can be included in the decision-making and strategy-devising activities, the stronger will be their motivation to invest themselves in the project.
Careful study, by all members of the action group, of the recommendations of the Cooperative Commission on the Study of Alcoholism, should precede the decision- and strategy-making steps. The Commissionís major report (Alcohol Problems, A Report to the Nation) is an invaluable resource for any clergyman or lay church leader who is searching for fresh insights and directions in the churchís approaches to alcoholism. Church groups have an opportunity to help implement its salient recommendations in cooperation with other groups at both the local and national levels. 9.
4. Plans were formulated on how to proceed on the chosen project, and work was begun. It is important for a group to concentrate its efforts on one project at a time, to have frequent evaluation sessions on the progress of the project, and to draw in such resource people as may contribute to achieving the goal of the project. One aspect of planning is for task force members to consult with others who have attempted similar projects and to read relevant reports and other literature. A congregation considering a ministry to alcoholics and their families, for example, might well read the summary of the seminar on "The Pastoral Care Function of the Congregation to the Alcoholic and His Family." This seminar was sponsored by the Department of Pastoral Services of the National Council of Churches. 10. Sources of literature and guidance include local Councils on Alcoholism, the National Council on Alcoholism, and denominational social problems agencies. It is encouraging that several of the major denominations have developed plans and resources in the areas of alcoholism education, community action, and rehabilitation. 11. It may be productive for a minister or task force member to write to several denominational agencies, in addition to his own.
The five-pronged approach described above for use by a local church can also be used advantageously by denominational and ecumenical groups in their planning of alcoholism strategy. There is a need for each denomination to develop its own unique style and contribution, but there is also a need for much increased cooperation by religious groups across denominational, faith, and national lines. This is the place where ecumenical bodies such as the National Council of Churches and the World Council of Churches (perhaps in cooperation with the World Health Organization) have a major opportunity to provide coordination and joint strategy designing.
If the influence of church groups is to make a contribution in relation to the federal mental health and alcoholism programs (in the U.S.), it will have to be expressed through ecumenical channels. In the light of this, it is fortunate that a foundation for joint action was laid in a statement adopted by the General Board of the National Council of Churches in 1958. Here are some excerpts:
The churches share a pastoral concern for alcoholics, problem drinkers and their families. . . . Alcoholics are persons in need of diagnosis, understanding, guidance and treatment. They are especially in need of pastoral care and the divine love which the church can bring them. . . . Ministers and churches should not be content merely to direct alcoholics to treatment centers.
The concern of the churches for alcoholics and their families is being shared increasingly by the community as a whole. We look to the member churches of the National Council to encourage the establishment and maintenance of clinics and other appropriate therapeutic facilities when competently conducted, for the victims of alcoholism. . . - The churches should disseminate such sound information as is now available concerning the understanding and counseling of persons with alcohol problems. The churches have a special responsibility to assist pastors to become more effective counselors in this field. 12.
The Key -- The Helperís Personality
If a minister or layman desires to maximize his effectiveness in any dimension of the alcoholism field; he must become competent in both skills and knowledge about the illness. But there is one factor which is more important than either of these: his personality and particularly his feelings about himself in relation to alcoholics and other deeply troubled persons. To the extent that he possesses a therapeutic attitude toward himself and others, he will be able to use his knowledge and skill. This attitude will be reflected in his relationships with alcoholics and their families. It will show in his tone and manner as he participates in alcoholism education. His approach to prevention and alcoholism action projects will be colored by it. In short, his ability to implement strategies in all five areas -- education, prevention, community outreach, helping alcoholics and their families -- will be influenced by the relative presence or absence of the therapeutic attitude.
The nature of this basic personality orientation has been illuminated by research in the field of counseling and psychotherapy. A study reported by Carl R. Rogers points to three components which are a part of what I am describing as the therapeutic attitude: Congruence, empathic understanding, and unconditional positive regard. 13. Congruence means genuineness as a person. Rogers declares, "The most basic learning for anyone who hopes to establish any kind of helping relationship is that it is safe to be transparently real." 14. Congruence involves knowing oneís feelings and owning them. The most important thing a person brings to any helping or teaching relationship is himself -- unbidden and real. Congruence is particularly important in working with alcoholics. They are hypersensitive to its absence -- "being a phoney" or "putting on an act."
Empathic understanding means being able to "tune in" on the inner world of feelings and meanings of another person. It means being with him in terms of what really matters to him behind his façade. In relating to an alcoholic, empathic understanding means that one is able to understand, to an appreciable degree, the chaotic complexity of his fears, guilt, despair, and hopes. This understanding, which is a thing of the heart as well as the head, is crucially important because of the alcoholicís feeling of haunting aloneness in a bizarre world and his belief that others could not possibly comprehend.
Unconditional positive regard means warm, human regard for the individual as a person of unconditional worth. With his fragile self-esteem (hidden by his defensive grandiosity), the alcoholic desperately needs positive regard. He hungers like a starving man for the acceptance he cannot give himself. The alcoholicís emotional immaturity causes him often to react in ways that are selfish, irresponsible, and impulse-ridden. This makes it difficult for a helping person to remain accepting and nonjudgmental. It helps to remind oneís self that he is the way he is, in large measure, because of some inadequacy in his early relationships which blocked his emotional growth. The thing that Longfellow said about our enemies is equally applicable to the alcoholic: "If we could read the secret history of our enemies, we should find in each manís life sorrow and suffering enough to disarm all hostility." The link between empathic understanding and unconditional positive regard is very direct.
Acceptance of the alcoholic is dependent, as has been suggested, on the helping personís acceptance of the reality of the illness from which he suffers. This is the basic reason for the emphasis which has been placed on the sickness conception of alcoholism throughout this book. A prerequisite for any constructive approach to the problem is the recognition that alcoholism is not an isolated problem, but a part of the total sin and sickness of our society -- a sin and sickness in which all of us are participants. The problems of the alcoholic are the problems which all of us share in differing degrees and with varying symptoms. This sense of involvement in the total cultural problem, of which alcoholism is one painful expression, and an honest recognition of our complicity in the kind of world which produces alcoholics are the points at which we must begin. This was where Lyman Beecher began over a century ago when he wrote concerning alcoholism, "For verily we all have been guilty in this thing." 15. We can choose no better starting point today.
The recognition by the helping person that he has a basic kinship with the alcoholic, that he is not better but only luckier that his symptoms are different, helps him to accept the alcoholic without condescension. This is the application of Tillichís "principle of mutuality," mentioned earlier. Deep inside himself, the helping person must be aware of the fact that the alcoholic is not essentially an alcoholic. He is essentially a human being with alcoholism. This affirms the alcoholicís humanity and provides a link with the humanity of the helping person. To be able to establish this link the person must be aware of his own dark side, his own inner conflicts, dishonesties, anxieties, compulsions, and grandiosities. The surrender experience is as important for the minister or lay worker as it is for the alcoholic. 16. It is also equally important that they be aware of the grace and acceptance of God in their own lives. Otis Rice put the matter in this way, in a talk to a group of ministers: "More than anything else we need to learn to love the alcoholics. The only way I know to do this is to remember that God loves them, and to remember how much he puts up with in order to love us." The words of Tolstoy come to mind at this point: "Only he who knows his own weakness can be just to the weaknesses of others."
The therapeutic attitude begins to dawn as the helping person senses, in the presence of the alcoholic or of his spouse, that "there but for the grace of God go I!" It exists more fully as he moves beyond even this to the deflating awareness -- "There go I!" This fellow feeling lowers the walls which block the flow of healing forces in the relationship.
Retaining this fellow feeling is very difficult for most of us. To identify with the essential humanness of the despairing threatens our fragile defenses against our own despair. To recognize that the [alcoholic in D.T.s] is more like than different from oneself shakes the very foundation of our defensive self-image. To accept this truth at a deep level is possible for most of us only to a limited degree. It requires an inward surrender of subtle feelings of self-idolatry and spiritual superiority. One student referred to this as "getting off the omnipotence kick." Even a partial surrender of oneís defensive superiority feelings helps to open the door to mutually redemptive relationships. Somehow it melts a hole in the icy barrier of pride that freezes real self-esteem and keeps people -- especially disturbed people -- at a distance. 17.
The helping personís own religion can help him maintain the therapeutic attitude. He knows that he is only a finite and fallible instrument, through which the healing, growth-producing forces of life can, at times, operate. He is aware of the fact that, at best, he is an imperfect channel for the flow of these God-given forces. Because of this he is better able to accept the fact that there are many people he cannot help or whom he can help only in very limited ways, no matter how hard he tries. This awareness makes it easier for him to avoid the false humility of unproductive self-blame when he fails, and to look honestly at his approach to discover weaknesses or mistakes which need not be repeated. Because of his own experiences of growth, reconciliation, and healing, he has a confidence in the power of the divine forces in every person which makes these experiences possible. This faith helps to prevent him from applying the easy label "hopeless" to the people he cannot help.
The therapeutic attitude includes a realistic awareness of oneís limitations as an instrument of growth and health; but it also includes an awareness of oneís potentialities as such an instrument. A certain alcoholic had been drunk nearly every night for five years. During his drinking he considered himself an agnostic. Finally, he came into AA, and at the time I heard him speak, he had been sober for three-and-a-half years. Here is what he said about how he was helped by a minister:
For the first seven months in AA I was dry on conceit and ego pride. I had nothing to do with the higher Power, and no support from the outside. I stayed sober, but itís a hell of a way to stay happy. At the end of that time my wife told me, "Youíre just as drunk in your mind as you ever were." I went to have a talk with a member of the local clergy. That day I saw the grass, the buds, the sky in a way Iíd never seen them before. Iíve never lost the experience I had that day, and I now have a speaking acquaintance with Someone greater than myself.
We do not know what the minister did or said in his meeting with this man. But it is safe to assume that, whatever it was, it occurred within a relationship to which the minister brought the precious ingredient which I have called the therapeutic attitude. The results of the encounter were more immediate than is usually the case in working with alcoholics (or others). But the helpfulness of the contact is not atypical.
In this meeting of two human beings, decisive events occurred which changed the direction of a manís existence -- turning him toward life, opening his eyes to the world around him, and beginning his relationship with "Someone greater than myself." Ministers and other persons of religious dedication can be instruments in such a life-transforming process. This is the challenge and the satisfaction of working with the alcoholic and his family.
1. H. R. Niebuhr et al., The Purpose of the Church and Its Ministry (New York: Harper & Row, 1956), pp. 83ff.
2. See Clinebell, Basic Types of Pastoral Counseling, Chapter 16, "The Laymanís Ministry of Pastoral Care and Counseling."
3. Here are a few of the many resources available for use in alcoholism education: The two basic books are Raymond C. McCarthy, ed., Alcohol Education for Classroom and Community, A Source Book for Educators (New York: McGraw-Hill Book Co., 1964); and Margaret E. Monroe and Jean Stewart, Alcohol Education for the Layman (New Brunswick, N.J.: Rutgers University Press, 1959). The latter is an annotated list of library materials -- books, pamphlets, articles, films, and filmstrips -- for use in alcohol and alcoholism education. The Association for the Advancement of Instruction about Alcohol and Narcotics produces a newsletter which contains useful material. Background books include: the AA and Al-Anon books; Marty Mannís New Primer on Alcoholism; Arnold B. Come, Drinking: A Christian Position (Philadelphia: The Westminster Press, 1964); Wayne E. Oates, Alcohol In and Out of the Church (Nashville: Broadman Press, 1966).
4. 2 East 10 3rd Street, New York, New York.
5. "A Survey of Local Church Activities and Pastoral Opinions Relating to Problems of Alcohol," QJSA, VIII (March, 1948), 636-56.
6. Robert E. Bavender, "Rehabilitation in Brentwood," The Methodist Story, November, 1964, pp. 39-40.
7. From a leaflet describing the program.
8. This is the term used by the "Samaritans," laymen who staff crisis counseling centers in the British Isles and elsewhere, to describe their work.
9. Another resource for the action group is a report entitled Alcohol and Alcoholism (Public Health Service Publication No. 1640), produced by the National Center for Prevention and Control of Alcoholism, Chevy Chase, Maryland 20203, in 1967. It gives a brief survey of present scientific knowledge concerning the causes, treatment, and prevention of alcoholism; describes present research and that which is needed; and outlines the national alcoholism program. For a survey from the international perspective, see "Services for the Prevention and Treatment of Dependence on Alcohol and Other Drugs: Fourteenth Report of the WHO Expert Committee on Mental Health" (Geneva: World Health Organization Technical Report Series, No. 363, 1967). This report summarizes the WHO approach to drug dependence and describes treatment, education, training, and research programs in various countries.
10. This seminar was held at Columbus, Ohio, October 12-14, 1962.
11. The Episcopal and Methodist Churches have done pioneering in this area. The North Conway Institute, which meets in New Hampshire each summer, provides a channel for interdenominational collaboration and discussion of the problem of alcoholism. On the international scene, it is noteworthy that one of the sections of the Twenty-Eighth International Congress on Alcohol and Alcoholism (held in Washington, D.C., October 1968) was on "Religion and the Church."
12. Statement adopted February 26, 1958, at New York City.
13. On Becoming a Person, pp. 47-49.
14. Ibid., p. 51.
15. F. W. McPeek, "The Role of Religious Bodies in the Treatment of Iniebriates," Alcohol, Science and Society, p. 406
16. For an illuminating discussion of this point, see John E. Kellerís Ministering to Alcoholics.
17. Clinebell, Basic Types of Pastoral Counseling, p. 297. (The words "alcoholic in D.Ts" substituted.)
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