Harm Reduction Therapy

Harm reduction, or harm minimization, accepts that idea that many people can’t or won’t completely stop using drugs or alcohol. The term “harm reduction” refers to a framework for helping reduce the harmful consequences of use when abstinence is not a realistic option. Although harm reduction was originally and most frequently associated with substance use, it is increasingly being applied to a multitude of other behavioral disorders. A core tenant of harm reduction is a relaxation on the emphasis on abstinence as the only acceptable goal and criteria of success. Instead, smaller incremental changes in the direction of reduced harmfulness of drug use are encouraged and accepted. Think a therapist armed with harm reduction techniques might be right for you? Reach out to one of TherapyDen’s harm reduction experts today.

Meet the specialists

I believe that your safety and concern is important and should be the top priority. Even when you are using substance or drinking, you should receive treatment when you are ready not when you have stopped using. Combined with Motivational Interviewing, Harm reduction focuses on your safety even if you are using, you deserve to get the best treatment that I can provide.

— Barry Tan, Counselor

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use, sex work and sexual activity. This approach does not encourage or require sobriety, abstinence, or the discontinuation of sex work but, instead, places quality of individual and community well-being as the criteria for successful interventions and policies.

— Madison Alvarez Brunk, Registered Mental Health Counselor Intern in Longwood, FL

I understand that for some people with some disorders it may not be easy to stop problematic behaviors completely. I help people make changes where they can and when they can in an attempt to live more satisfying lives in a safe way. I work with people who are struggling with self-harm, eating disorder symptoms, drug and alcohol abuse and help them find ways to manage symptoms and behaviors as best they can in the moment.

— Joy Zelikovsky, Psychologist

Harm reduction recognizes that a person’s relationship to drugs and alcohol is often complex, and takes a non-judgmental approach to helping people reduce the negative impact of substance use, abuse or dependence in their lives. One essential Harm Reduction principle, that is qualitatively different from the 12-Step model, is that any amount of improvement is a good thing.

— Paul Silverman, Marriage & Family Therapist in San Francisco, CA

I am not here to ask you to give up anything you need. I strive to honor what care, coping, and surviving look like for you at any given time. I want to support you in exploring any goals you have around behavior change and help you make changes that are a good fit for you. And I approach this work with gentleness, compassion, and flexibility.

— Colette Gordon, Counselor in Portland, OR

People aren't perfect and relapse is not failure. I've learned through my experience with clients who misuse substances that living and working conditions are not always optimal for promoting abstinence. In these cases, harm reduction is very useful but not always offered or tolerated in treatment programs. As a certified advanced alcohol and drug counselor, I embrace and utilize any proven therapies that are beneficial to my clients.

— LATEISHA ELLIOTT, Licensed Professional Counselor in Huntsville, AL

Many clients who struggle with substances are not interested or able to pursue total sobriety. These folks have every right to treatment and a nonjudgemental partner to help them explore the role of alcohol and drugs in their lives, and to create manageable, self-directed goals. I specialize in helping folks moderate their alcohol use when they recognize it is having negative effects on their lives. I also encourage clients to find support and community outside the therapy room, offering suggestions and referrals when helpful. This may mean attending support groups that do not promote abstinence as the only acceptable goal; joining an online community of others who are also moderating; using a moderation workbook; or attending harm reduction therapy groups.

— Maysie Tift, LMFT, Licensed Marriage & Family Therapist in San Rafael, CA

When working with clients who have substance use concerns I will meet them where they are at in their journey. I do not believe it is my decision as a counselor to force sobriety, or to encourage a client to take steps that they are not ready for. I believe in reducing the harm of using any substance and following the client's lead in the change process.

— Lauren Lewis, Licensed Professional Counselor in Loveland, CO

Harm Reduction work involves instilling hope, focusing on safety, and not waiting for someone to go through the pain and lasting damage of hitting “rock bottom.” For over two years, I ran a Harm Reduction residential program for veterans, and now I supervise a Drop-In counseling center for veterans with a Harm Reduction focus. I have attended the national Harm Reduction conference and learned from some of the leaders of this progressive approach to helping people who use substances.

— Jacob Donnelly, Licensed Clinical Social Worker in Berkeley, CA

Sometimes, the idea of complete abstinence from a substance or behavior is too much to handle. My belief is that this should not keep you out of therapy. Through harm reduction, we can make small changes piece by piece while working through the other issues. It is important to push yourself in therapy, but I do not believe that it has to be an all-or-nothing approach. Harm reduction definitely isn't for everyone, but it is an option to be explored for those who are hesitant to start therapy out of fear of letting go of unhealthy ways of coping.

— Jessica Kilbride, Clinical Social Worker in White Plains,

2.5 years in addiction counseling with focus on harm reduction

— Jennifer Rosselli, Licensed Mental Health Counselor in Acton, MA

Harm reduction begins with the basic assumption that it is possible to have healthy relationships with the behaviors and substances you choose to engage with in your life. Harm reduction does not demand abstinence, but sometimes taking a break can help you get a new perspective. If you are concerned that you have an unhealthy relationship with a substance, habit, or even a person, let's take an honest look together to find ways to reduce harm and increase your sense of satisfaction in life.

— Lucius Wheeler, Licensed Professional Counselor Intern in Portland, OR

Self-Harm Reduction Therapy helps people work through their pain & suffering, instead of staying “stuck” and increasing it. Distress Tolerance is a DBT Skill that I teach clients, so they learn safe ways to survive crisis situations without making them worse. When we can accept reality for what it is, we can free ourselves from our own personal prison, and safely move forward to build a healthier life worth living.

— Cassie Icenogle Konnoly, Licensed Mental Health Counselor in Lacey, WA

At the core of harm reduction therapy is a respect for human rights. Working from a harm reduction approach means that I meet you where you are and on your own terms when it comes to substance use of any other behaviors deemed "harmful" by society. My question is, "what would you like your drug use or sexual behaviors to look like," and we can work from your answer to determine how you can be safe and comfortable.

— Liz Silverman, Licensed Clinical Social Worker in Brooklyn, NY

As a clinician with experience working with addiction, homelessness, sex work, and abuse, I take a strong harm reduction approach. I understand that change does not happen overnight, and have extensive knowledge of harm reduction-based coping strategies.

— Natalie Winicov, Clinical Social Worker

When working with people who are coping with self-harm, addiction, and body image issues I take a self-harm approach. I have found that an abstinence only approach does not work for many people who are scared to completely give up a behavior that might be their only source of comfort. I work with clients in order to help the reduce the problematic behavior in order to help reduce the harm they are causing to themselves or loved ones. Sometimes this leads to client's dropping the maladaptive behavior completely or sometimes it means helping them manage it to the best of their ability. Of course this approach is not right for everyone. For people who need a higher level of care I offer educational consulting for inpatient treatment and make referrals as necessary.

— Elizabeth Sockolov, Associate Marriage & Family Therapist in Petaluma, CA

Harm reduction means meeting you where you are and supporting you in the goals you have. That could include sobriety, reduction in use or exploring anywhere in between. There are no ultimatums.

— Frances Shelby, Therapist in Austin, TX

I studied over 10 different models of recovery, including Women For Sobriety, Rational Recovery, Seven Weeks To Sobriety, and Solution Focused Problem Drinking, to name a few. My belief is that many addiction and mental health issues are trauma based. I love Harm Reduction the most because it is a first step into what's underneath.

— Diane Adams, Clinical Social Worker in Alberton, MT

I help you work towards YOUR goals, not a goal set for you. We can explore what you want your life to look like in relation to substances and set a plan to get there.

— Stephanie Taylor, Mental Health Counselor in Belton, TX

I developed a harm reduction outpatient treatment program for the State of Minnesota. This program worked with clients on gaining tools to significantly reduce their chemical use, improve quality of life, and decrease impact of the chemical use on the community. Many of the clients determined their goal was complete abstinence as they gained confidence in the ability to access coping tools in high risk situations. They also worked on reduction of mental health symptoms.

— Julia Murtha, Drug & Alcohol Counselor in Minneapolis, MN

Rebecca has worked with a lot of individuals who have current maladaptive coping strategies (e.g. nonsuicidal self-injurious behavior, substance use, etc.), and she has worked with client in harm reduction strategies that are the first step towards self-care.

— Rebecca Neubauer, Licensed Clinical Social Worker in Los Angeles, CA