Therapeutic confrontation provides direct and reality-based feedback on an individual’s behavior, thoughts, or feelings. It has been used a lot in addiction treatment as a means to force the individual to face their problems. This confrontation approach may be instigated by the therapist or it can occur within a group setting. Attack therapy is the most controversial use of this type of treatment and there is some evidence that this can lead to psychological damage. The use of audio and video self-confrontation is less controversial but there are still concerns about the effectiveness and appropriateness of this approach.
Self-confrontation using videotape is a means by which the individual can confront their own behavior. This type of tool can be of use for those who are in denial about their actions because it is difficult to dispute such recorded evidence. It may help the individual gain a better understanding of their situation and so be able to move forward in therapy.
There are a number of different ways that video self-confrontation can occur. One of the earliest examples of this technique was used during the 1950s to treat alcoholics. It was referred to as cinematographic psychoshock and involved recording the client while they were drunk. When the client was sober they would then be confronted with their poor behavior which would be captured on film.
Videotape self-confrontation has also been used where therapists conduct an interview with the client. Throughout this interview attempts will be made to prod the client into reacting defensively with the aim of highlighting their mechanisms for denial and self-delusion. This videotape can then be used in further sessions to confront the client with their problems. Other methods of videotape self-confrontation simply involve recording previous therapy sessions and pointing out any inconsistencies to the client.
There is not much evidence to support the effectiveness of videotape self-confrontation. Although there were claims in the 1950s of success rates of up to 45%, this has not been backed up by further studies. In fact some research has shown that videotape self-confrontation may increase the likelihood of relapse. In one study those who had received this type of treatment tended to return to alcohol abuse sooner than those who didn’t undergo videotape self-confrontation.
Critics of confrontational therapy express a number of concerns regarding its appropriateness and effectiveness. One worry is that it might further lower the self-esteem of people who are already vulnerable in this regard. The client might not feel ready to face their demons and forcing them to do so could be a traumatic experience. The idea that it is necessary to break people down before they can be rebuilt is dangerous and may even lead to irreparable harm. There is also the worry that those who are given the role of confronting the individual may abuse this power. It may be that approaches such as videotape self-confrontation are not appropriate for those working within a therapeutic profession.
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