The Weekend University

Harm Reduction Psychotherapy: An Introduction - Dr Andrew Tatarsky, PhD

Oct 30, 2025
Dr. Andrew Tatarsky, a pioneer in Integrative Harm Reduction Psychotherapy, shares insights from his 35-year journey in addiction treatment. He emphasizes a compassionate approach that meets clients where they are, challenging the limitations of abstinence-only methods. The conversation delves into the psychology of addiction, exploring motivations behind substance use and the importance of the therapeutic alliance. Techniques like 'urge surfing' highlight mindfulness in managing cravings, promoting healthier coping strategies without immediate demands for abstinence.
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INSIGHT

Start By Asking Their Goals

  • Harm Reduction Psychotherapy starts by asking the client "What are your goals?" rather than imposing abstinence.
  • Keeping the clinician's agenda to the side creates a safer space for genuine exploration and change.
ANECDOTE

From Abstinence Programs To Harm Reduction

  • Andrew Tatarsky describes working in abstinence-only programs and later breaking the rules to help actively using clients in therapy.
  • That shift, and mentorship from Alan Marlatt, led him to develop Integrative Harm Reduction Psychotherapy.
ANECDOTE

Personal Treatment Trauma Shaped His Work

  • At 15 he experienced a therapeutic community that turned abusive after he 'broke a rule', causing lasting trauma and dissociation.
  • That treatment trauma later motivated him to create a more compassionate, empowering alternative.
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