An Outdated Treatment Model with Damaging Effects: The Case Against Confrontation

Over the past century, medical sciences have greatly evolved making many past methods of treatment seem barbaric or inhumane.

For example, did you know that people used to calm teething babies by slathering their gums in a balm that contained morphine? Or that syphilis was once treated with arsenic and mercury?

As we’ve gained new knowledge and resources, these treatment methods that were once widely accepted are now considered to be outdated and dangerous. However, this hasn’t only been true in the world of physical health.

The history of mental health is also marked by treatments that were not only harmful, they were completely ineffective. But unlike the use of arsenic and mercury as medicine, some of these damaging approaches to mental health are still practiced today.

The History of Confrontational Therapy

From the 1920s to 1950s, addiction treatment shifted dramatically. What was once regarded as a biological illness suddenly became a character flaw. Sufferers were no longer seen as innocent victims of their addiction, but vicious people with inflated egos.

Dr. Lawrence Kolb, pioneer of this theory, believed addicts had defective, psychopathic personalities born out of severe social maladjustment, a presumption that not only pins addicts as villains, but also creates a blanketing stereotype for all addicts that is deeply untrue.

In his therapy model, Kolb assumed that because clients were exposed to a drug-free social model during treatment, that they would continue along that path once released. To no surprise, this treatment plan proved to be ineffective and resulted in a high level of relapse.

As a response to these findings, Dr. Harry Tiebolt developed confrontation therapy, a treatment based on the theory that if you break down an addict’s defense, it will deflate their narcissistic ego and result in surrender. Once they hit rock-bottom, the counselor would then have the opportunity to build them back up.

Addiction Treatment Methods

Built upon the groundwork of this emerging confrontational method, four assumptions were made about those suffering from addiction. These outlandish assumptions defended the necessity of confrontational therapy.

  1. All addicts have rigid defense mechanisms that conceal their immature, defective nature
  2. The previously used passive methods of treatment are widely ineffective
  3. The protective defense shield of addicts must be broken by force
  4. Verbal confrontation is the most effective way to treat addiction

Addiction Treatment Methods - Confrontational Therapy


As you can imagine, the therapy model that developed through the implementation of these four assumptions included the denunciation of character, intentional humiliation, coercion, ultimatums, and intense argumentation.

Even when it became more widely acknowledged that suffering is rooted in repressed feelings rather than a egotistic nature shielded by defense mechanisms, attack therapies were still utilized to tear down the masks of addicts and encourage them to be “real.”

During this time, counselors believed it was their role to correct the errors of their clients, combat their perceived delusions, execute power over them, break down their defenses, and provide them a link to reality.

The confrontation method was first utilized in a peer-group setting in which members communicated with each other by sharing their unedited opinions and perceptions about the other members.

This quickly developed into a “hot seat” style session in which one member sat in a designated chair while the others were free to critique and point out character flaws.

Before long, it became apparent that this approach was doing more harm than good, but by the time the “hot seat” became the “love seat” at the end of the 1970s, confrontation techniques were being utilized in a professional setting.

This authoritative relationship provided even more room for abuse and long-lasting harm to addicts.

Progression of the Confrontational Method

By the 1980s to 1990s, confrontational method of addiction treatment had to be adapted to accommodate for adolescents, greater numbers of staff, and an increase in outpatient treatment models.

During this time, the harsh confrontation method moved toward constructive discussion that embraced empathy, honesty, and acceptance.

In the early 1990s, Dr. Carl Rogers introduced the idea that it is the job of counselors to hear and understand their clients. He believed that in the confrontation method, clients began to see themselves as unacceptable and unable to change, whereas empathetic counselors had the power to motivate their clients and encourage lasting behavioral shifts.

His model of best practices included supportive, non-judgmental interpersonal relationships rather than power-driven, shame-inducing methods.

Progression of the Confrontational Method of Addiction Treatment

Confrontation Today

In reflecting on the decades focused on confrontational techniques, it has become apparent that this model is not effective. While many clinical studies were performed to create a case for confrontation in addiction treatment, not one provided positive results.

In fact, most showed increased dropout rates, more rapid relapse rates, and a higher likelihood of DWI offenses.

We now know that the previously accepted notion of an “addictive personality” is not a reality and addicts do not share definitive characteristics.

In addition, confrontation has proven to invoke resistance and defensiveness which, studies have shown, does not result in behavioral change.

Based on these findings and the widely acknowledged inhumane nature of the confrontation method, it seems reasonable to assume that this treatment model is no longer utilized. Unfortunately, that is not the case.

In a 2001 poll conducted by the National Institute of Drug Abuse, 46% of staff surveyed believed that confrontation should be implemented more frequently, and in 2004, a study uncovered programs within the spectrum of addiction treatment that were designed to demean their clients.

The Alo House Approach to Treatment

At Alo House, we oppose any treatment that utilizes abusive or judgemental forms of confrontation.

We believe in a compassionate care model® in which we treat our clients with empathy and acceptance.

It is the goal of our counselors to actively listen and understand our clients, show them respect, and encourage self-confidence.

Through treatment modalities such as motivational therapy, psychodrama, cognitive behavioral therapy, and existential therapy, it is our goal to engage with our clients in a way that preserves their dignity and teaches responsibility.

Our rehabilitation philosophy is based on providing non-judgmental, loving support. This close-knit, community-based approach aims to empower our clients and provide them with a sense of comfort and belonging.

Read more about our philosophy and treatment model here.

alo house

We believe trust, meaningful connections, and kindness are the essentials to beginning a journey in recovery. We are dedicated to providing an honest, authentic, and genuine treatment environment that gives our clients a unique opportunity for healing.

Alo House is LegitScript Certified and a Joint Commission Accredited Addiction Treatment Center.