Therapy and the 12 steps

People with addiction issues might hear this from a therapist: “Twelve-step programs are a good start, but only therapy will help you understand yourself and address deeper issues.” And they might hear this in the rooms: “Everything you need, you get by working the steps.”

12-steps therapyOf course, the truth is much more complex than either simple statement. For people who struggle with addiction-related issues, the integration of psychotherapy and the 12 steps is often the best approach; many of the elements of good therapy, and of 12-step programs, are similar or complementary. Undertaking the work of recovery can bring up a host of old patterns, ways of being in the world, and relationship dynamics that benefit from the more individualized and exploratory work of therapy; if your therapist understands the principles of 12-step programs, he or she can better understand your struggles and be supportive around an important part of your life. In this article, I will illustrate some ways in which therapy and 12-step programs are similar, and other ways in which the two approaches are complementary.


The first step – admitting that you are powerless over your addiction and that your life has become unmanageable – is also the critical beginning for therapy. You acknowledge that you have a problem and step outside of yourself to fully comprehend the destructive nature of the compulsions that undermine your life, conflict with your interests, and interfere with your ability to mature and to grow.

Step 2 (coming to believe that a Power greater than yourself can restore you to sanity) has a kind of analog in therapy. For change to occur in therapy, you come to trust your therapist and have faith that he or she can help you. You open up and believe that your therapist can be compassionate and caring, and that he has your best interests in mind.

Steps 4 and 5 are also similar to therapy in that they address self-exploration, self-disclosure, and confession. Step 4 involves making a searching and fearless moral inventory of yourself, and step 5 is admitting to God, yourself, and another person the exact nature of your wrongs. In a 12-step program, it is often your sponsor who listens to your inventory or your expression of secrets that you have hidden and feel shame about. Trust is an essential and necessary element in both relationships.

It is important to note that if you have experienced serious trauma, and early victimization, therapy with a professional is often the best place to talk about these experiences. Although doing a 12-step inventory focuses on your part in contributing to negative situations in your life, it can be destructive to look for “your part” in situations where you have in fact been victimized, and had no responsibility.

Working together

In other ways, therapy and the 12 steps are complementary. Your recovery community provides a sense of belonging in a group and of feeling accepted – fellowship, in program terms. Overcoming addiction requires that you develop a sober social network as an alternative to the people, places and things that trigger the addictive behaviors you are working so hard to set aside.

The 11th step encourages you to continue to take action and maintain a spiritual connection, to seek knowledge of what is good for you, and the power to carry that out. Therapy can support this effort. Therapy is also augmented by the 12th step, which exhorts addicts to carry the message to other addicts, and to practice these principles in all your affairs – to give back. Therapy does not offer a sense of community, and may have less focus on taking action; therapy will encourage you to understand yourself and integrate your insights throughout your own life. In this way, combining therapy with a recovery community provides you with a powerful and holistic approach to dealing with addiction issues.

Belonging to a group may be something you never experienced before in a positive way.  Perhaps you were not supported by your family of origin, which is your first group experience. Twelve-step groups are cohesive, yet there is no leader, no authority figure telling you what to do; instead, other members offer suggestions, allowing you to take what you can use and leave the rest. By their nature, 12-step programs provide an accepting group experience. Being part of a non-judgmental group can have a number of positive effects for you. First of all, you are not judged, but importantly, you also learn how to react with compassion to others.

Twelve-step programs and psychotherapy are not mutually exclusive. Rather, they can reinforce each other and provide help for you as a whole person. While there is some overlap, and there are some differences between the two, the differences are not in conflict. In fact, they can provide synergy to promote your overall welfare spiritually, emotionally, socially, and physically.

Article Name
Therapy and the 12 Steps
The combination of therapy and participation in a 12-step program can provide a cohesive approach to helping you deal with and overcome addiction issues.

About Marc Handelman, PhD

I am a licensed clinical psychologist practicing in New York City. My office is located on the Upper West Side of Manhattan, near Columbia University. I work with adults from college age and up who want help addressing problems ranging from depression, anxiety, and relationship issues to addiction, co-dependency, and the effects of early trauma. I believe psychotherapy should provide a sense of comfort and support as the starting point for addressing emotional problems. I have more than 30 years' experience as a psychotherapist, and have been affiliated with The Hazelden Foundation since 1997. Please see my professional website for more information:
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