CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
A 12 STEP THEORY FOR GENERAL WELL-BEING
A graduate project submitted in partial fulfillment of the requirements
For the degree of Masters of Science in Counseling,
Marriage and Family Therapy
By
Laura Rhodes-Levin
December 2014
The graduate project of Laura Rhodes-Levin is approved:
____________________________________________
Bruce Burman, Ph.D.
___________________
Date
____________________________________________
Dr. Ian Russ, Ph.D.
___________________
Date
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Dana Stone, Ph.D., Chair
___________________
Date
ii
Dedication
I dedicate this project first and foremost to the founders and members of
Alcoholics Anonymous, with out which I could never have accomplished much of the
gifts life now holds for me. For this reason I also dedicate this project to my sponsor
Donna Paul, my sponsees Krystal Usher, and Kimmie Griffin. Each and everyday these
ladies contribute to my emotional sobriety by going above and beyond the duties of the
program to connect with me on levels of love, caring and friendship.
I also dedicate this paper to my father Michael Rhodes, who is clearly doing so
much on my behalf since his crossing into the afterlife. The love and support he gave me
in life and now in death nurture my soul in ways words cannot describe, but the heart can
deeply feel. I love you daddy, and miss you more than I could every say.
In addition to my father, my mother Nina Hughes and my step father David
Hughes have been a cradle of support in my academic journey, as well as my life journey.
My mother has always led to me believe that I could accomplish anything I set my mind
to. Her belief in me has brought fruitfulness and adventure to my life in ways I could
never have known without her. My step father is actually the person who pointed me in
the direction of psychology, a path which has enabled me to find my driving force and
intended purpose on this earth.
I owe thanks to both my brother Ross Rhodes and my sister Camila Rhodes who
know me better than any other on earth. They are not just siblings, but best friends. They
have both endured endless phone calls supporting me on my way to and from school,
work etc. They help me to remember who I am when I am feeling lost, and they have
loved me through every period of my life dark or light. In addition, they gave me the gift
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of the only children I will have the chance at raising my beautiful nephews Ethan and
Zen, and my wonderous niece Ella.
I must include in this dedication the Summers family. My aunt Suzie has not only
supported me emotionally, but she made it possible monetarily to reach beyond my
means and achieve a life of success and prosperity. My cousins Jordan Summers and
Jolie Summers Garwood have been nothing less than a brother and sister to me, including
me in all their journeys and forever extending me unconditional love.
Last but not least, I dedicate this project to my beautiful husband Ken Levin. He
has encouraged me to be who I am, shown me love beyond my wildest dreams, and holds
me so close and caringly when I hurt. He is truly my rock. I am so blessed to be his
wife.
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Acknowledgments
I would like to extend the deepest gratitude to my editor, Professor Rebekka
Helford. Her devotion to the works she does is greatly apparent in all of my experiences
with her. She genuinely cares about the students she works with and offers a spirit of
hope and inspiration. I found my work with her to be extremely life affirming and
encouraging.
I would like to thank Professor Diane Gehart in helping me to name my theory,
and for all of her support in moving my project forward. Her presence at the university
and the impact she has had on the Marriage and Family Therapy program is dynamic. Her
desire to keep the program current and thriving is ever present.
In addition, I would like to thank my chair Professor Dana Stone, and my
committee members, Professor Bruce Burnam, and Professor Ian Russ for taking time to
help me with my project. The members of my committee have outside obligations,
beyond their commitment to the university, and the extra effort spent to help me further
my project is greatly appreciated.
I would also like to acknowledge my fellow students who contributed to the
growth of my paper. Thank you to Mike Randleman, Fabiola Lazarte, Kellie Schimdt,
Karen Rivas, and Abbey Ronquillo. The support I felt from the members of my cohort
will be forever appreciated and cherished.
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TABLE OF CONTENTS
Signatures
ii Dedication
iii Acknowledgments
v Abstract
viii Chapter One: Introduction
1 Background of Problem
Statement of Problem
Purpose of the Project
Significance of the Project
Definition of Terms
Summary
2 5 5 6 7 9 Chapter Two: Literature Review
11 The 12 Steps and the 12 Step Theory for General Well-Being
Step One
Step Two
Step Three
Step Four
Step Five
Step Six
Step Seven
Step Eight
Step Nine
Step Ten
Step Eleven
Step Twelve
Martin Seligman and Learned Optimism
Viktor Frankl and Logotherapy
Carl Jung
Conclusion
Chapter Three: Developing the Project
12 14 15 16 16 18 19 20 22 23 24 26 28 29 30 35 37 39 Development of Project
Intended Audience
Personal Qualifications
Environment and Equipment
Project Outline
39 39 40 40 41 Chapter Four: Project Overview
42 vi
Summary of Project
Recommendations for Implementation
Recommendations for Future Research
Conclusion
42 42 43 44 References
47 Appendix: Project: THE 12 STEP THEORY FOR GENERAL WELL-BEING
58 vii
ABSTRACT
A 12 STEP THEORY FOR GENERAL WELL-BEING
By
Laura Rhodes-Levin
Master of Science in Counseling,
Marriage and Family Therapy
The following project is an exploration of the psychological components of the 12
Step Program designed in 1939 by Bill Wilson and Dr. Bob Smith to aid in the recovery
of suffering alcoholics by taking a spiritual approach to life’s difficulties. When
examined closely, the original 12 Steps contained in the program for alcoholics embody
key aspects of logotherapy, analytical psychology, and positive psychology. The purpose
of this project is to propose a new theory for the field of psychology currently titled The
12 Step Theory for General Well-Being, which incorporates an application of the 12 Step
Program to aid in the recovery from symptoms such as depression and anxiety. The
philosophy behind the new theory for the mental health is to provide a therapeutic
process with basis of healing through a spiritual connection to the field of mental health.
viii
Chapter One: Introduction
Originally started by Bill Wilson and Dr. Bob Smith in 1939, the 12 Step Program
was designed to help alcoholics recover from the disease of alcoholism. Before the
creation of Alcoholics Anonymous (AA), multitudes of people drove miles and miles to
meet with fellow alcoholics whom had recovered from their disease. The success of these
recovered alcoholics was the catalyst for the writing of the basic text of AA (1939).
Today, there are over 200 support programs founded on the 12 Step Program to
deal with dysfunctions such as gambling, food addiction, shopping addiction, sex
addiction, and many more (Sober Nation, 2014). However, even after the dysfunctional
coping mechanisms of alcohol, food, gambling, etc., are eliminated, the primary root
symptoms of addiction, such as anxiety and depression, remain present in the individual
(Bartels et al., 2013). The 12 Step Program helps individuals recover from the symptoms
of anxiety and depression, as well as the addiction itself.
The Anxiety and Depression Association of America (1999) supports the view
that 12 Step Programs are effective in arresting symptoms such as depression and anxiety
by employing a spiritual approach to life. Worley, Tate, McQuaid, Granholm, and Brown
(2012) investigated the effects of 12-step work on depression as measured by the
Hamilton Depression Scale. All participants presented with substance dependence, as
well as major depressive disorder. Some of the participants received 12 Step Facilitation
(TSF), and the rest of the participants received Cognitive Behavioral Therapy (CBT). The
study was done on an outpatient basis over a 6-month period. The results showed the TSF
group scored significantly higher than the CBT group and improvement in depressive
symptoms (2012).
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Background of Problem
Symptoms such as depression and anxiety are not limited to substance abusers.
According to the Anxiety and Depression Association of America (1999), the most
pervasive form of mental illness in the United States are anxiety disorders, which affect
40 million adults (18% of the U.S. population). Additionally, 3-5% of people suffer from
major depression, with a lifetime risk of 17%. The Centers for Disease Control and
Prevention (2012) state that depression and anxiety affect one in five Americans.
The types of individuals experiencing mental health issues in the United States
today span across many cultures, races, and religions. According to Mental Health
America (2014), 30-40% of Latinos born in the United States experience mental illness.
The American Psychiatric Association (2013) reported that the suicide rates of Asian
American women are significantly higher than the rates of women of other races.
Furthermore, according to the U.S. Health and Human Service Office of Minority Health
(2012), 20% of African American adults report more serious psychological distress than
White adults.
The American Psychological Association (2013) recently cited an increased
importance in the improvement of psychological services to ethnic and culturally diverse
populations due to a growing political and social presence of diverse cultural groups.
Furthermore, psychological service providers are in need of developing a framework to
navigate diversity of values, skills for assessment and intervention, interactional styles,
and cultural expectations (2013). According to Cooper and Denner (1998), psychological
theories tend to make the assumption that nations are culturally homogeneous. Due to
global demographic changes and massive immigration, there is a challenge to improve
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the validity of psychological theories and their applications, aligning them with the
cultural diversity experienced in the field of psychology today.
Twelve Step Programs have provided effective support and recovery for
individuals from many different cultural groups, such as Caucasian, African American,
Hispanic, Asian, and Pacific Islanders. Due to its efficacy in treating the symptoms
underlying alcoholism and other addictions, such as depression and anxiety, as of 2001,
Alcoholics Anonymous has been printed in 43 languages (Wilson & Smith, 2001).
Caetano (1993) stated that AA is well known among Hispanics and African-Americans.
Caetano further asserted that a vast majority of ethnic groups generally recommend AA.
Robertson (1988) reported that AA has a huge, expanding international attraction and is
able to assist the multi-ethnic and multi-racial demands of today’s American population,
spanning the diverse social classes, sexual orientations, and gender that now make up
33% of the total North American AA membership.
As mentioned earlier, the 12 Step Program introduces the individual to a spiritual
foundation as an effective method in arresting symptoms of depression and anxiety.
According to Koenig (2008), the importance of integrating spirituality into patient care
has grown exponentially in the last few decades. In 1992, three medical schools offered
courses on religion, spirituality, and medicine. Of the 141 medical schools in both the
United States and Canada, more than 100 offered such courses (70% of which are
required) as of 2006. Spirituality—a connection to God or a Higher Power, as it is
defined in the 12 Step Program—is not limited to the idea of any one particular God.
Perhaps it is the freedom for the individual to choose his/her own concept of Higher
Power that makes the 12 Step Program so widely applicable. With a base in spirituality,
3
12 Step Programs provide coping skills symptoms including anxiety and depression by
addressing issues of resentment, fear, defects of character, making amends, and giving
back to society (2008). Spirituality plays an important role in many different cultures in
diverse ways. Avruch (1998) speculated that cultures are composed of derivatives of
experiences whose interpretations and meanings are learned from past generations,
current generations, and individuals themselves.
According to the National Alliance on Mental Illness (NAMI, 2004), spirituality
and faith play a very important role in the African American community. Two psychiatric
case histories presented by Carter (2002) found that questions asked during health
assessment regarding religion/spirituality significantly influenced treatment decisions and
results in African Americans. Hanna and Green (2004) stressed how little consideration is
given to the spiritual background of Asian students in school counseling. The authors
further found very few articles regarding counseling as it applies to Asian spiritual and
religious practices. Hanna and Green felt Asian students could be served better if
empathy towards spiritual aspects of Asian traditions were addressed (2004). In addition,
the Network for Multicultural Research on Health and Healthcare (as cited in Robert
Woold Johnson Foundation, 2009) found that 70% of Latinos feel that spiritual healing is
essential to the maintenance of health and well-being. Therapists have an ethical
responsibility to be culturally competent in order to remain masterful in the field. As a
result, it is important for therapists to be able relate to people from different cultural
backgrounds in a framework that is effective. Since spirituality is important to a variety
of cultures, it would make sense to use a treatment model that incorporates spirituality.
4
Therefore, the 12 Step Theory for General Well-Being could be a helpful tool for
therapists working with diverse populations.
Statement of Problem
There are very few theories in the field of mental health focused on integrating
spirituality in treatment. Further, there are even fewer empirical studies regarding the use
of spirituality in therapy, indicating a gap in knowledge about the importance of
spirituality in treatment. Koenig (2008) suggested that surveys of psychiatrists in the
U.S., Canada, and Great Britain indicate a widespread prejudice against religion and very
minimal inclusion of spirituality in the treatment of psychiatric patients. Furthermore,
according to McSwain (2012) of the Huffington Post, religious institutions are showing
dwindling of attendance while the quest for spirituality is thriving. Frankl (1959) felt the
search for the meaning of life is not new to the individual, stating that man’s search for
meaning is the root of human angst. According to Harper and Le Beau (2001), United
States pollsters and scholars show that the majority of Americans believe in supernatural
forces and have thirst for a spiritually enhanced life. This statement is supported by the
researchers’ assessment of the myriad of Americans who provide a large market for
religious/spiritual books, tapes, music, and paraphernalia, as well as the presence of
voting patterns based on religious and/or spiritual beliefs (2001).
Purpose of the Project
The purpose of this project is to create a new theory based on the foundations of
the 12 Step Program (Wilson & Smith, 1939) for therapists to use to help their clients
overcome mental health issues including but not limited to anxiety and depression in
order to achieve mental well-being. The primary root of the theory is based on spiritual
5
connection. This theory is necessary in order to fulfill the need for a spiritually based
approach to mental health. The freedom for the individual, with whom the theory is used,
to define his/her own concept of God or a Higher Power will be instrumental in the
viability of the model to many different applications of spirituality. The 12 Step Theory
of General Well-Being will be an inclusive theory for individuals from a variety of
cultural backgrounds, thereby bridging diversity issues related to spirituality that may be
limited with the use of current theories of mental health.
Significance of the Project
The human condition of mental well-being in conjunction with the need for
spirituality can be accessed through the 12 Step Theory for General Well-Being.
According to Shafranske (1996), approximately 10% of new psychologists report the use
of religious sensitivity or guided practices in their training, and he claims psychologists
agree there is a need to develop theoretical models connecting of mental health and
spirituality. The proposed theory is such a model.
In addition to accessing spirituality, the 12 Step Theory for General Well-Being
offers a wide reach regarding the inclusion of many different cultures. Griner and Smith
(2006) conducted a meta-analysis of 76 studies: to date, the only research that had tested
the impact of culturally competent interventions. The studies involved in their analysis
were composed primarily of the comparison of culturally adapted mental health
interventions to traditional mental health interventions. Their meta-analysis indicated a
moderate effect size for culturally competent interventions (2006). As mentioned earlier,
the 12 Step Program has evidence for successful application to culturally diverse
populations (Alcoholics Anonymous, 2010).
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Definition of Terms
Corrective emotional experience: According to Bridges (2006), a term coined by
Franz Alexander, Hungarian-born psychoanalyst and physician, describing the process by
which the patient and therapist revisit past traumas the patient has experienced in
childhood, usually with the mother or father figure. The patient re-witnesses the traumas
with the therapist, who provides the patient with a good experience that is corrective in
that it contrasts with what the patient has experienced with his/her parent (2006).
Defects of character: Dysfunctional behaviors that impact the individual’s life
negatively (Wilson & Smith, 1939).
Ego/pride: Components of self-justification brought on by conscious or
unconscious fears. Ego and pride are the producers of most human difficulties and are the
primary blocks to true growth (Wilson & Smith, 1939).
Essence of existence: A concept asserting that man is responsible for his life and
must actualize the potential meaning of his life. Essence of existence is the individual’s
motivational force (Frankl, 1959).
Existential frustration: The striving and angst involved in an individual’s need to
find concrete meaning in his/her personal existence (Frankl, 1959).
Existential vacuum: The concept that humans have to make choices about their
lives above and beyond mere base animal survival (Frankl, 1959).
God/The Universe/Higher Power: A spiritual force, defined by the individual, that
is stronger than the individual himself/herself (Wilson & Smith, 1939).
Learned optimism: The process of viewing ones life’s experiences that are either
positive or negative with a positive outlook (Seligman, 1990).
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Logotherapy: A form of psychotherapy devised by Victor Frankl (1959) based on
the Greek logos, defined as meaning. Logotherapy’s tenets propose that life has meaning
in all circumstances, finding life’s meaning is an individual’s main driving force, and
people have the freedom to assign meaning to life’s circumstances that they choose.
Meaning of life: The meaning an individual assigns to his/her own experiences
that defines life itself (Frankl, 1959).
Moral inventory: A list of events that has caused an individual to have
resentments, the behaviors the individual engaged in to facilitate the listed events, and the
fears that drive the behavior behind the resentment (Wilson & Smith, 1939).
Powerlessness: A concept referring to the lack of control an individual has over
people, places, and/or things.
Self-actualization: The process of the individual realizing his/her full potential
(Schott, 1992).
Self-awareness: An individual’s ability to perceive how his/her actions and
thoughts impact the world around himself/herself (Jung, 1966).
Self-love: The act of having compassion for oneself, including having compassion
and understanding for dysfunctional behaviors (Simons, 2010).
Self-talk: The manner in which an individual dialogues internally either positively
or negatively with himself/herself (Seligman, 1990).
Shortcomings: Dysfunctional behaviors that impact the individual’s life
negatively (Wilson & Smith, 1939).
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Spiritual awakening: The transformation an individual experiences when having
seen and/or experienced a connection with the Universe/Higher Power (Wilson & Smith,
1939).
Spirituality: Transcending oneself in relationship with the Universe/Higher Power
through prayer, meditation, interactions with nature or others. Spirituality is a broader
concept than religion, but religion is often inclusive of spirituality (Burkhardt, 1989).
Transformation: The process of an individual looking inward in order to facilitate
a change within himself/herself in order to achieve his/her own fullest potential (Jung,
1966).
Twelve step program: A series of steps created by the founders of AA to aid and
facilitate recovery from alcoholism that is now used to treat other addictions as well
(Wilson & Smith, 1939).
Unmanageability: The individual’s inability to cope with his/her life (Wilson &
Smith, 1939).
Summary
When examined closely, the 12 Step Program incorporates many of today’s wellrespected theories, such as, positive psychology, logotherapy and analytical psychology.
The 12 Steps offer concepts about various approaches to life similar to those suggested
by theorists such as Seligman, Frankl, and Jung, in addition to possessing a strong basis
in spirituality. In the field of mental health, it is not uncommon for an individual to seek a
specific kind of therapy such as psychoanalytic, cognitive behavioral therapy, or positive
psychology. Although each of these approaches is effective in its own right, the 12 Step
9
Theory for General Well-Being offers both the therapist and the individual access to the
benefits of many theories in one cohesive unified theory.
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Chapter Two: Literature Review
The 12 Steps of AA originated from Bill Wilson and Dr. Bob Smith (1939) as a
guide for helping the suffering alcoholic to lead a sober, more peaceful way of life.
According to the authors, the 12 steps were considered to be “a design for living that
work in rough going” (1939, p. 14). In addition to the millions of alcoholics that have
recovered from the disease of alcoholism via the 12 steps, according to Sober Nation
(2014), there are countless other groups who have applied these 12 steps to many other
obsessions, such as gambling, food, sex, and hoarding, to name few. The primary root
symptoms that drive addiction are anxiety and depression (Bartels et al., 2013).
The 12 Step Program includes features also found in several different respected
models currently utilized in the field of mental heath: models based on the philosophies
of highly regarded theorists such as Seligman, Jung, and Frankl. The following review
will explore the aspects of Seligman, Jung, and Frankl’s models that are related to the 12
Step Program and that are applicable to the 12 Step Theory for General Well-Being.
As mentioned previously, cultural diversity and spirituality are significant
components of the 12 Step Program. The multi-cultural expansion in the United States
and the need for culturally competent counselors has become pertinent to the field of
mental health in recent decades. According to Cooper and Denner (1998), a challenge for
the mental health field is to improve the applicability of current psychological approaches
of therapy, which aligns with the U.S.’s prevailing cultural diversity. The U.S. office of
the Surgeon General (1999) released a report highlighting the disparities that minorities
in the United States receive in regard to mental health care. The 12 Step Program is
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currently offered in 41 different languages (Alcoholics Anonymous, 2010) because of the
need for its use and effectiveness in aiding a multi-cultural world.
The gap between spirituality and psychology has also been recognized in the new
millennium. The Mental Health Foundation (2008) has defined spirituality as an
important element in aiding people sustain good mental health and recover from mental
health issues. Spirituality can be experienced in several different ways, such as a feeling
of belonging/connectedness, faith, direction and meaning in life; a way of understanding
the world and an individual’s place in the world; religion; or a quest for wholeness,
harmony, and hope (2008).
Chapter Two will first present an overview of the theories designed by Martin
Seligman, Viktor Frankl, Carl Jung, and the 12 Steps of Alcoholics Anonymous,
followed by a detailed description of the conversion from the traditional steps and well
known theories to a new theoretical model The 12 Step Theory for General Well-Being.
The conversion will be accomplished by adapting the steps and offering applications
from various concepts of psychology to support each one.
The Success of Alcoholics Anonymous (AA)
At the time of its printing, the fourth edition of the Alcoholics Anonymous, stated
that in 2001 AA had a membership reaching upwards of 2 million, having doubled its
membership since the printing of the third edition (Wilson & Smith, 2001). Due to the
construct of anonymity, AA does not allow scientific research to be done by any outside
affiliations. However, a study done by AA in 2007 found that in following 8,000 of AA’s
North American members for 10 years, 33% had remained sober (AA Membership
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Survey, 2008). Alcoholism has baffled the medical community for decades. Silkworth
(1939) penned for the first printing of Alcoholics Anonymous.
I have specialized in the treatment of alcoholism for many years. I personally
know scores of cases who were of the type with whom other methods had failed
completely. These facts appear to be of extreme medical importance because of
the extraordinary possibilities of rapid growth inherent in this group, and may
mark a new epoch in the annals of alcoholism. These men may well have a
remedy for thousands of such situations. (p. xxv)
The medical community stills touts the successes of 12 step programs today. A
study done by Florentine (1999) at UCLA followed 262 subjects in Los Angeles were
just being released from 26 drug treatment facilities in order to track the results of their
newly achieved sobriety. The study was based on self-report, and the researcher found
that subjects who attended at least one 12 step meeting per week upon release from drug
abuse treatment facilities showed significantly lowered illicit drug use than those
attending less than one meeting per week or who did not participate in a 12 step program
at all. Almost 50% of patients took part in weekly 12 step meetings in the first six
months. During this 6-month period, 22% of weekly 12 step participants had taken illicit
drugs. By contrast, 44% of participants who went to 12 step meetings less than once a
week or not at all had in fact used illicit drugs (1999).
Further analyses based on a self-report scale showed more favorable results of
weekly 12 step attendees than were found for subjects who chose different post-treatment
choices, like aftercare programs (Florentine, 1999). Subjects participating in weekly
meetings scored higher than nonparticipants for recovery motivation. Statistically,
13
different post treatment choices accounted for minimal success in comparison to the
positive outcomes for weekly 12 step attendees (Florentine, 1999).
To explain to individuals who are not familiar with the 12 steps of recovery, it is
important to understand the concepts and reasoning behind each step. In the next section,
the original 12 Steps of Alcoholics Anonymous will be explained in conjunction with the
concepts the steps represent in the unified theory of the 12 Step Theory for General WellBeing.
The 12 Steps of AA
As explained by Wilson and Smith (1939), upon entering a 12 Step Program,
participants are guided by another member of the 12 Step Program, known as a sponsor,
through a series of steps that offer the individual the ability to arrest her/his alcoholism.
In addition to being freed from addiction, the 12 Steps help the individual develop skills
to cope without alcohol, such as revealing resentments, identifying fears, searching out
dysfunctional behaviors, and freeing oneself from shame and guilt (1939).
Step One
According to Wilson and Smith (1939), the wording of step one is, “We are
powerless over alcohol and that our lives have become unmanageable” (p. 59). In
programs that adopt the 12 Step structure for their own purposes, the word alcohol is
replaced with the appropriate compulsive behavior with which the individual identifies,
such as eating, failing to clear clutter, or using cocaine. It is important to note that
compulsive behavior is not limited to the use of a substance.
Compulsive behavior is present in individuals who have a dysfunctional need to
control the people, places, or things around them. According to Richmond (2011a),
14
therapists are repeatedly bombarded with complaints about the behavior or circumstances
being experienced by the individual through the course of his/her day. Richmond stated
that these frustrations present themselves in myriad ways, be it the desire to control a
mother-in-law, a husband, a boss, a political body, traffic, or sometimes even the rain.
According to Beattie (2005), negative feelings such as depression and anxiety can be
attributed to the lack of control. Anxiety is a common symptom experienced when
individuals cannot find peace unless able to control the people and situations around
them.
Step Two
The wording of step two is, “Came to believe that a power greater than ourselves
could restore us to sanity” (Wilson & Smith, 1939, p. 59). The recent interest in
complementary and alternative medicine has reintroduced the importance and
interrelatedness of spirituality and medicine. Spirituality is also gaining efficacy in the
field of mental health. The World Health Organization (1998) declared that the medical
model, which persistently focuses on treating individual with medicine and surgery, is no
longer adequate, and argued for the inclusion of elements such as faith, compassion, and
hope.
Koenig, McCullough, and Larson (2001) published The Handbook of Religion
and Health, a comprehensive look at decades of research on studying the connection
between religion/spirituality and a wide range of mental and physical health conditions,
including but not limited to cerebral-vascular disease, heart disease, high blood pressure,
immune disorders, cancer, and longer life. Over 1,000 studies and almost 500 reviews of
15
research were presented. On average, a correlation of 60-80% was found between those
who incorporate religion or spirituality into their lives and better health (2001).
Step Three
In step three, the connection of spirituality builds on the faith cultivated in step
two. Step three by Wilson and Smith (1939) reads, “Made a decision to turn his will and
his life over to the care of God, as we understand God” (p. 59).
A study conducted by Rosmarin (2011) on 332 subjects belonging to some form
of religious organization at Harvard-affiliated McLean Hospital determined that subjects
who held belief in a power greater than themselves had lower levels of stress and a
greater tolerance for uncertainty than the control group subjects who held no spiritual
affiliation. In regard to the study, Rosmarin stated that the field of psychiatry must
recognize and take into consideration the importance of spirituality (2011). Since
psychiatry and psychology have the mutual goals of mental health, it should be
considered that spirituality might be important in the psychotherapeutic setting as well.
Step Four
According to Wilson and Smith’s (1939) the wording of step four is, “Made a
searching and fearless moral inventory of ourselves” (p. 59). When examined closely,
fear underlies anger. In this inventory, Wilson and Smith (1952) required that the
individual list all the resentments he/she is carrying while examining the dysfunction the
resentments have created in his/her life, and searching for his/her behaviors in each of the
written resentments. The individual then goes on to list what fears are attached to these
resentments. Jung (1935) felt that the process of working with individuals and analyzing
their past brings to bear all the attentiveness and critical judgment the therapist can
16
summon in showing the patients their mistaken paths and the misconceptions they might
hold about their past were an essential part of achieving transformation.
By taking responsibility for one’s part in resentments the individual no longer
feels helpless. Wilson and Smith (1939) found resentment to be the number one offender
and the root of all forms of spiritual disease. Resentment leads to anger, and anger is a
cover for fear. Namka (2002) explained that anger is a cover for vulnerability, but
because anger is so complex, very few individuals have the skills to express the fears that
lie at the root of the anger. If it is true that anger masks the truth of an individual issue,
then the choices an individual makes when experiencing anger do not address the real
issue at hand.
A study conducted by Kligyte, Connelly, Thiel, and Devenport (2013)
demonstrated the impact of anger on ethical decision-making. The study involved 163
undergraduate psychology students, 63 men and 100 women, at a Midwestern university.
The subjects were randomly divided into two groups for experimental conditions. One
group experienced a manipulation for fear, the other a manipulation for anger. The results
indicated that the group that underwent the anger manipulation showed a lesser ability for
ethical decision making than the group operating out of fear. Therefore, when operating
out of anger, instead of acknowledging the true issue of fear, the individual is apt to make
choices in life that do not align with her/his well-being (2013).
Step four facilitates the opportunity for the individual to alter his/her behavior by
understanding the fear beneath his/her anger and helps the individual make decisions
about his/her relationships with more clarity and less dysfunction. When the individual is
able to examine the fear at the root of his/her resentment, he/she is able to step away from
17
the anger and resentment and find the skills to express his/her authentic role in the
interaction at hand (Wilson & Smith, 1939).
Step Five
“Admitted to God, to ourselves, and to another human being the exact nature of
our wrongs” (Wilson & Smith, 1939, p. 59). Step five involves sharing the inventory
written in step four with another person, such as a sponsor, a clerical figure, or a
therapist. Step five is the admission to another of the anger, guilt, and fear the individual
has kept to himself/herself. This step is akin to the concept of confession discussed earlier
in the paper (Jung, 1996). Just like Jung (1996), Farish (2010) postulated that confession
is representative of shame and a hidden self, and the act of releasing the shame is healing
and liberating to the individual who does so.
Kasin (1997) argued that the curative benefits of confession have been largely
overlooked by the scientific community, which is similar to step four. According to
Smelser and Baltes (2001) Josef Breuer and Sigmund Freud observed that patients often
felt better after purging their minds of material buried in the unconscious. At the root of
confession are shame and guilt. Namka (2002) described shame and guilt as forms of
self-talk that says I am bad. Shame and guilt then become a separation from the
individual’s real self. The separation from self in turn becomes a separation from others,
leading individuals to isolate.
Wilson and Smith (1939) concur that step five is the process by which emergence
from shame and guilt for the individual is facilitated. As the therapist creates a safe place
for the individual to air his/her shame and guilt, together the therapist and the individual
are able to examine the fears the individual has been harboring. A case study of a 28-year
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old suicidal woman by Sweezy (2011) discussed the regulation of shame through
discussion, the processing of shame and guilt with the therapist, and the curative effects
created by the exposure of the shame and guilt. At the end of the study the woman no
longer entertained suicidal thoughts. Step five, like that of the woman is Sweezy’s study,
offers the individual the opportunity to shed shame and guilt.
Step Six
The wording of step six is as follows, “Were entirely ready to have God remove
all these defects of character” (Wilson & Smith, 1939, p. 59). It is important to note that
step six is only a listing of the defects of character. Acknowledging and listing the
defects is what, according to Wilson and Smith (1939) makes the individual ready to
have them removed. The actual removal of the defects commences in the following step
seven.
In step six the individual makes a list of the behaviors he/she has identified as
dysfunctional in step four. In step four the individual has let go of the shame and guilt
associated with the dysfunctional behaviors; therefore, in step six, these defects of
character are associated with compassion for self, not shame and guilt. Step six offers the
chance for the individual to fully identify and focus on the dysfunction with compassion
and humility (1939).
Ellis (1975) claimed that individuals must often behave in a dysfunctional manner
in order to recognize their dysfunction. In this regard, the dysfunctions the individual has
experienced so far now become an asset in her/his mental health recovery, for it is only
by knowing these dysfunctions firsthand that the individual is able to move beyond them.
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Frankl’s (1952) view on the meaning an individual assigns to an event is relevant
in step six. In step six the individual assesses his/her dysfunctional behavior (Wilson &
Smith, 1939). Many individuals develop behaviors based on defense mechanisms they
acquired early in life (Jung, 1935). It is in step six the individual acknowledges the
meaning of the dysfunctional behavior as a possible survival tool. The knowledge of self
acquired in step six (Wilson & Smith, 1939) is similar to the education component
offered by Jung (1935), whereby the individual recognizes he/she no longer needs the
dysfunctional behavior to survive and the individual is now ready to compassionately
learn new tools that reconstruct his/her behavior.
In their study Breines and Chen (2012) involving students at the University of
California, Berkeley, the researchers hypothesized whether self-compassion for
wrongdoings and transgression helps to improve self-motivation. The subjects were
examined through self-report about feelings regarding test failure and the admission of
failure as it related to future test scores. The researchers suggest that taking an accepting
approach to personal failure makes individuals feel more motivated to improve
himself/herself and higher future test scores indicated the value of acceptance (2012).
Step six provides the individual a chance to accept his/her failures, in order alter future
behavior for the better.
Step Seven
Step seven is as follows: “Humbly asked him to remove our shortcomings”
(Wilson & Smith, 1939, p. 59). Step seven absolves the individual from removing his/her
own shortcomings. How will God remove the individual’s shortcomings?
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In the aforementioned step six, the individual has made a list of dysfunctional
behaviors through a compassionate lens. Moving forward, step seven offers the
individual the opportunity to cease participating in dysfunctional behavior and engage in
purposeful behavior. The individual now looks to God and his/her higher self for the next
right action he/she takes (Wilson & Smith, 1939). Jung (1966) held that this higher self
can be accessed from within, stating, “This ‘other being’ is the other person in ourselvesthat larger and greater personality maturing within us, whom we have already met as the
inner friend of the soul” (p. 264).
Step seven is an exercise in humility. Step seven upholds the concept that the
individual is deserving of compassion and has the ability to be compassionate, regardless
of his/her character defects (Wilson & Smith, 1939). The practice of humility is based on
kindness and acceptance for the self (Jung, 1935). The 12 Step Program holds at its core
the idea of self-love and the love the Universe/Higher Power holds for the individual
(Wilson & Smith, 1939).
Bridges (2006) conducted a case study of three separate patients and the
corrective emotional experience using the operational measures of emotional arousal,
emotional experience, emotional expression and emotional processing, accompanied by
in-session data and the Experiencing Scale which was developed by Klein, Mathieu,
Gendlin, and, Kiesler (1969). Bridges (2006), found that in all three patients, the ability
to access feelings of compassion for self through the process of the corrective emotional
experience was restorative and the clients were able to achieve emotional regulation as a
result.
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Step seven provides a corrective emotional experience (Alexander & French,
1946) in a relationship with the Universe/Higher Power. Through the loving and curative
relationship with the Universe/Higher Power, the individual is able to implement
functional and positive behaviors in place of the former dysfunctional and negative
behaviors.
Step Eight
Step eight is the first action the individual takes for atonement (Wilson & Smith,
1939). “Made a list of all persons we had harmed and became willing to make amends to
them all” (Wilson and Smith, 1939, p. 59). In step eight the individual is given the
opportunity for reconciliation. The term reconciliation comes from the Latin words re,
meaning again, and conciliare, which means to bring together, so reconciliation means to
make friendly again (Richmond, 2011b). Wilson and Smith (1952) contended that it is
important to look backward and try to discover where one has been at fault.
Dryden and Branch (2008) postulated that when an individual accepts the act of
breaching his/her moral value system, the individual acknowledges the fallibility of being
human. Frankl’s (1959) insistence on the importance of responsibility is inherent in step
eight. In step eight the individual does not condone his/her behavior, but rather takes
responsibility for the behavior (Wilson & Smith, 1939). According to O’Hanlon and
Bertolino (2011), making amends can be a way to find closure or relieve guilt or shame.
Through step eight, the individual is able to release the shame and guilt uncovered
through his/her work in the previously discussed step four when writing his/her moral
inventory (Wilson & Smith, 1939). Coleman (2008) contended that the philosophy of
making amends extends beyond the individual. As a couples’ therapist, Coleman believes
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an important predictor of rebuilding trust after an affair is the capacity for both members
of the couple to take responsibility for the infidelity (2008).
Todd (1995) claimed that Jung’s idea of confession was the bridge between
psychology and religion. The act of secret keeping, in Jung’s (1935) view, alienated the
individual from his/her community. Todd reviewed the work of Jung and formulated the
notion that guilt reflects the overlap between psychology and religion. As discussed
previously, guilt and shame are detrimental to the individual’s well-being. Step eight in
the 12 Step Program begins the process of shedding guilt and shame brought on by
dysfunctional behaviors because the individual begins to consider how he or she will
make amends with important others (Wilson & Smith, 1939).
Step Nine
Step nine from Wilson and Smith’s (1939) 12 step program states, “Made direct
amends to such people whenever possible, except when to do so would injure them or
others” (p. 59). Step nine is act of restoration of relationships that were negatively
impacted by the individual’s dysfunctional behaviors. The individual approaches each
person or institution listed in the aforementioned step eight and makes restitution for the
behavior experienced by the person or institution.
Step nine is not conducted in the face of shame and guilt, but rather humility and
the strength on the individual’s part in the admission of being human and therefore
fallible. Step nine’s amends refers to humility (Wilson & Smith, 1939). Having
acknowledged the benefits of personal humility in step seven by asking God to remove
his/her shortcomings, Wilson and Smith extended the concept of humility as the
individual’s personal relations are concerned in step nine (1939). Through two
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longitudinal studies on relational humility, Davis et al. (2010) asserted that humility can
promote the strengthening of social bonds. The first study Davis et al. conducted
involved 123 romantic relationships of college students who had experienced hurt by
their partners in the 2 months prior to the study. The researchers sought to predict lack of
forgiveness in the absence of humility and forgiveness. When the offending partner
exhibited humility, the researchers found that forgiveness resulted (2010).
According to Baskin and Enright (2004), reconciliations or apologies restore
mutual trust. Apology is not just a social nicety. In “The Power of Apology,” an article
published in Psychology today, Engel (2002) asserted that apology was a key component
and a way of showing respect and empathy to the person who had been wronged. With
out acknowledging the act of wrong doing the relationship might be compromised. Step
nine in the 12 Step Program helps the individual to access the final act of emergence from
guilt and shame into well-being (Wilson & Smith, 1939). Making amends to persons who
have experienced wrong doing helps the individual to restore harmony in her/his
relationships.
Step Ten
According to Wilson and Smith (1939), step ten is about spiritual maintenance.
“Continued to take personal inventory and when we were wrong promptly admitted it”
(p. 59). In actuality, Step ten is a short form of steps four, six, eight, and nine. The
previously discussed step four represents the accumulation of resentments and
dysfunctional behavior that led to the resentments up to the point of beginning therapy.
Step six recognizes the dysfunctional behavior, and step eight and nine facilitate the
reparation of harm done by the dysfunctional behavior and action. Step ten is the daily
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maintenance of current resentments and dysfunctional behavior the individual is
experiencing, the acknowledgment of the person harmed at present, and the immediate
amends to such person. Having done step nine to repair the outcome experienced with
dysfunctional behavior, Step ten provides a process for the individual to maintain healthy
well-being (1939).
From an etymological perspective, Doverspike (2012) noted that the concept of
forgiveness is derived from the Greek word aphesis meaning to release, to set free, or to
let go. Step ten creates the ability for the individual to release resentment as it is
experienced, rather than allowing resentment to fester. As experienced through the
amends process in step nine, the individual is able to address current resentments and
wrongdoings on regular basis rather than having them build up.
In a recent New York Times article, Brown (2013) described the process of
creating a circle in which members could sit and speak, in order to facilitate open
dialogue confronting wrongdoings. The circle prompts empathy in the individuals
affected by negative behavior and facilitates restitution sooner. Brown asserted that open
dialogue concerning wrongdoing by the individuals in the talking circles allows them to
let go of their resentment through forgiveness. The individuals who applies step ten to
her/his relationships can gain empathy from those he/she has wronged by promptly
admitting her/his wrongdoing.
Step ten for the 12 Step Program is a maintenance step for functional and happy
relationships in the individual’s life. At this point in the therapy, the individual has
acquired tools for well-being that produce more immediate resolution for the individual’s
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problems than the individual was capable of before acquiring the tools (Wilson & Smith,
1939).
Step Eleven
Step eleven is essential for the individual’s continual daily well-being and inner
peace. Wilson and Smith (1939) wrote step eleven as follows: “Sought through prayer
and meditation to improve our conscious contact with God, as we understood God,
praying only for knowledge of his will for us and the power to carry that out” (p. 59).
In step eleven, the Universe/Higher Power facilitates the removal of character
defects the individual has listed in the aforementioned step six. Step seven states,
“Humbly asked him to remove our shortcomings” (Wilson & Smith, 1939, p. 59). Step
eleven is the answer to the plea made by the individual in step seven to remove the
character defects uncovered in step six.
Step eleven is a request on the individual’s part that his/her Universe/Higher
Power present its will for the individual. Step eleven is a plea for guidance. In following
the guidance of one’s Universe/Higher Power, the individual is able to engage in new and
functional behaviors. Step eleven is the desire for support from his/her Universe/Higher
Power to show the individual a new way of being. The individual further asks his/her
Universe/Higher Power to give him/her strength to achieve the new way of being to
change the dysfunctional behaviors (Wilson & Smith, 1939).
In the first part of step eleven, Wilson and Smith (1952) want the individual to
pray based solely on character building. Step eleven steers the individual away from a
material-based value system. As the authors wrote the prayer for step eleven, they
indicated a belief that individuals lacked the point of view that holds character-building
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and spiritual values of the utmost importance. Wilson and Smith sought to steer the
individual away from the perspective that material satisfactions were the purpose of
living.
Step eleven involves two actions: prayer and meditation. Prayer is defined by
Merriam-Webster (2012) as a silent or spoken petition made to God or a god. Prayer is
the individual engaging in communication to his/her Universe/Higher Power.
Bushman, Bremner, and Koole (2011) also tested the effects of prayer. Subjects
were asked to write an essay involving an experience that angered them. The subjects
were subsequently given negative feedback on the essays they had just written.
Participants were then asked to take a few minutes to either pray for or simply think
about a young woman who was battling cancer. Participants who prayed reported less
anger towards the person who disliked their essay than those who thought about the
woman battling cancer. The prayer’s calming effects did not vary by gender or religious
affiliation (Bushman et al., 2011). Prayer can offer a calming effect for individuals
applying step eleven to situations that have evoked anger.
The second action in step eleven is meditation. Originally of Eastern roots,
meditation has made a stronghold in the Western world. Chopra (2013) claimed that brain
scans have shown physiological evidence of the effect of prayer and meditation on the
brain. By accessing the parts of the brain activated during meditation, the meditators had
achieved a healthier well-being (2013).
Kabat-Zinn (2003) observed brain waves in employees experiencing high levels
of stress. The subject pool consisted of 41 employees who were divided randomly into
two groups. Twenty-five participants engaged in learning meditation in the following 8
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weeks, while the control group of 16 employees conducted their lives normally. Both
groups received three brain scans spread out over the 8 weeks. The study revealed that
the meditators had a significant shift in activity to the left frontal lobe, causing them to
feel states of happiness and calm previously not experienced prior to the study (2003).
Step eleven helps the individual incorporate prayer and meditation into his/her
daily life. Prayer and meditation provide the individual maintain an ongoing connection
to his/her Universe/Higher Power, and promotes both physically and spiritually improved
states of well-being (Wilson & Smith, 1939).
Step Twelve
Step twelve is the final step. “Having had a spiritual awakening as a result of
these steps, we tried to carry this message to other alcoholics, and practice these
principles in all our affairs” (Wilson & Smith, 1939, p. 60). Sack (2012) stated that the 12
steps are not just about stopping one isolated behavior but learning a new way of life. In
completing all 12 steps the individual has identified dysfunctional behaviors, uncovered
resentments, shed guilt and shame, made restitution to those who had been impacted by
the dysfunctional behaviors, and achieved a happier and calmer mind, brain, and life. The
aforementioned transformations are the “spiritual awakening promised in step 12.
Wilson and Smith (1939) classified the spiritual awakening as the individual living a life
that is “happy, joyous and free” (p. 133).
In achieving the transformed self, the individual is then encouraged to help others
to do the same. In the words of Mahatma Gandhi (1913), “As a man changes his own
nature, so does the attitude of the world change towards him” (p. 241). Setting a good
example and helping others to do the same has emotional and physical benefits.
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The 12 steps when examined more closely are rooted in the works of theorists
such as Seligman, Jung and Frankl. The following section will more deeply examine the
components touted by the aforementioned theorists, as they apply to the 12 steps.
Martin Seligman and Learned Optimism
Learned optimism is a term coined by American born psychologist Martin
Seligman (1991). Seligman focused on the idea that a person can learn how to have a
positive outlook upon life by changing the talk she/he uses to communicate with
herself/himself from pessimism to optimism. An individual has an outlook of optimism
or pessimism depending on what type of self-talk is experienced internally. An optimist,
by definition, is an individual who has the inclination to view events in his/her life to be
favorable or have a favorable outcome. A pessimist views events in her/his life as having
a generally negative or unpleasant outcome (1991).
Negative self-talk is often experienced by those who suffer from depression. Two
studies conducted in Russia with 332 high school students using stability, globality, and
controllability subscales, determined that, for both negative and positive events, the
evocation of a positive outlook contributed significantly to the students’ well-being and
success using three different tests (Gordeeva & Osin, 2011).
Seligman’s (1991) term learned optimism means that if one must learn optimism,
one must start the journey of learned optimism first as a pessimist. Pessimism is
associated with health-damaging behaviors. Seligman’s approach of learned optimism
encourages individuals who suffer from depression, as well as those facing adversity, to
change negative self-talk into positive self-talk, thereby learning optimism (1991).
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Communication is often thought of as an exchange of information between two
people, when in fact, one actually has the ability to communicate with one’s self. Selftalk is the communication that takes place in a person’s mind between one and oneself
(Seligman, 1991). Self-talk is a language developed by an individual that dictates how the
individual perceives and narrates his/her experiences to himself/herself.
Stress management expert Elizabeth Scott (2014) asserted that positive or
negative self-talk starts at a very young age and impacts the amount of stress one
experiences throughout his or her life. A conducted by Creswell, Dutcher, Klein, Harris
and Levine (2013) at Carnegie Mellon measured whether positive self-talk had an effect
on the stress involved in problem solving. Eighty students at the university who identified
as suffering from chronic or acute stress were randomly divided between a control group
in which the subjects were simply given tasks without any suggestions or manipulation,
and a group utilizing positive self-talk. Both groups were assigned 30 problem-solving
tasks. The results indicated improved problem-solving abilities in the positive self-talk
group over the control group (2013).
Viktor Frankl and Logotherapy
Austrian born psychiatrist, neurologist, and Holocaust survivor Victor Frankl
(1959) had a unique approach to the field of psychology, via which he formed the idea of
logotherapy. Frankl considered logotherapy a way to heal by changing the meaning in
life’s experiences. Logotherapy was derived from the Greek logos, the term for meaning.
His theory proposed that there is purpose to everything in life, even in events or
circumstances that were terrible (1959).
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Logotherapy is based on meaning. First, the therapist and the client together try to
discover the meaning in the different circumstances the individual is experiencing in
his/her life. Frankl (1959) felt that meaning could not be given; it must be discovered.
The first step is changing the meaning behind life’s unpleasant circumstances, and help
the client come to the realization that he/she is not a victim of circumstances. He/she
might have symptoms, but he/she is not defined by the symptoms.
Frankl (1959) created a meaning triangle to help the individual view unpleasant
events differently. The meaning triangle consists of the following elements; first the
therapist and the individual seek to access the individual’s own creativity by helping
him/or recognizing the person’s talents, self and the gifts the individual gives to life.
Next, the individual is prompted to observe how he/she experiences the world through
relationships, nature, culture, and interactions with the world around him/her. Finally, a
change of attitude is essential in logotherapy. Even when the situation or circumstance
cannot be changed, the individual is encouraged to change his/her attitude toward a
condition in order to transcend the condition and find a new meaning, especially in
unavoidable suffering (1959).
The key concepts, for the purposes of this paper, in regards to logotherapy are
existential frustration, the existential vacuum, the meaning of life, and the essence of
existence. Frankl (1959) defined existential frustration as follows:
The term “existential” may be used in three ways: to refer to (1) existence itself,
i.e., the specifically human mode of being; (2) the meaning of existence; and (3)
the striving to find a concrete meaning in personal existence, that is to say, the
will to meaning. (p. 106)
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Therefore, man’s need to attach worth to his life is not a pathological illness, but rather a
tool that facilitates his growth in times of despair or crisis. According to Thorne and
Henley (2005), existential frustration comes from a misdirected sense of meaning, which
lead to the symptoms of depression, aggression, and anxiety.
Frankl’s (1959) existential vacuum refers to the idea that humans have to make
choices about their lives above and beyond mere survival. According to Frankl, it is the
ability to choose that makes us human. The existential vacuum separates man from
animal. Humans are not relegated to make choices based on their basic survival needs,
but rather to analyze and guess how to meet the needs of those around them, therefore
making him/her conform to situations which may cause one to sacrifice their own wants
and needs to please others (1959).
To define essence of existence, Frankl (1959) declares that “man is responsible
and must actualize the potential meaning of his life. Logotherapy tries to make the patient
fully aware of his own responsibleness” (1959, p. 114). The actions the individual takes
in the world create causal effects in his/her life. Denying participation in the outcomes of
one’s experiences can cause a person to become the victim, at the mercy of others in
his/her life, with no ability to affect his/her life directly. Being the victim creates a
scenario such that a person has no choice in how life unfolds. A person is strictly at the
mercy of the people, places, and things around him/her, unless he/she is able to recognize
the responsibility for the part he/she played in the situation (1959).
Logotherapy often focuses on responsibility, which applies to many categories of
life. An individual has responsibilities to himself/herself, to others, and to society (Frankl,
1959). The actions a person chooses to take toward people, places, and things have
32
causality in how life unfolds around the individual and what outcomes are produced by
these actions (Frankl, 1959).
An individual is often faced with situations in which he/she has absolutely no
control, such as war, work situations, disabilities, or even traffic, thereby being left only
with the way the individual chooses to interpret them. When an individual experiences
tragedy that is unchangeable, the event then manifests itself in that individual’s life based
on the attitude chosen by the individual in the face of the tragedy. Changing the outlook
and attitude about an experience can change the effect it has on an individual’s life
(Frankl, 1959).
Lastly, the meaning of life, as defined by Frankl (1959), is the meaning an
individual assigns to his/her own experiences that defines life itself. The meaning of life
is different for each and every individual. The meaning of one’s life and events that occur
can only truly be interpreted by the individual himself/herself (1959). One’s attitude
toward one’s life circumstances speaks of the potential for the individual to make
meaningful choices in situations of suffering and adversity (Gelman & Gallo, 2009).
Although logotherapy was created many decades ago, it is still considered
instrumental today. In a study by Julom and Guzman (2013), the logotherapy program
was utilized with 16 randomly selected, paralyzed in-patients of the Philippine
Orthopedic Center. The Purpose in Life Test (PIL) and the Life Regard Index (LRI) were
constructed based on Frankl’s concept that life is meaningful under all circumstances.
The PIL is an attitude scale constructed based on the orientation of logotherapy
(Crumbaugh, 1968; Crumbaugh & Maholick, 1964) and was designed to measure an
individual’s experience of meaning and purpose in life or to detect the presence of an
33
existential vacuum. These two tests were administered by Julom and Guzman (2013) to
the participants both before and after the participants received logotherapy. The results
demonstrated that with the help of logotherapy, it is possible to find meaning and
contentedness, even when confronted with a fate that cannot be changed (2013).
As mentioned earlier, Frankl (1959) propose that even the most terrible of
situations can be viewed as meaningful. Frankl insisted that an individual’s primary
concern is not to search for enjoyment or supremacy, but to discover the meaning of
existence (Ponsaran, 2007). Frankl (1959) proposed that searching for the meaning of life
was inherent to human nature, but the meaning one assigns to one’s life ultimately is
what creates the individual’s reality.
Recently, businesses and business managers have started using logotherapy to
introduce meaning into the work environment. Employees are often frustrated with the
mundane and repetitious activities of work (Devoe, 2012). The implementation of the
logotherapy program encouraged managers to enhance team building by sitting down
with the members of their teams and communicating the importance the employees
represented in the team as whole. This application of logotherapy enabled individuals to
see the meaning they brought to company through their work and how they added value
through the tasks they performed. Management’s acknowledgement to the employee of
his/her significance within the company fostered more positive employees attitudes
towards work. Thus, business managers are utilizing this meaning-driven therapy to
improve productivity and optimism in the working environment (Somani, 2009).
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Carl Jung
Carl Jung (1935), founder of Analytical Psychology, put forth the concept that life
is to be led with meaning. Although Jung’s work began to have an impact in the field of
psychology in the early 1900s, his theory still carries weight today. According to Kirsch
(2012), the last several decades have shown a renewed expansion of interest in Jung’s
psychology throughout the world, including places such as Australia, New Zealand,
Brazil, South Korea, South Africa, and more recently the Balkan countries.
Jung (1935), postulated that a meaningful life is one with a focus on the
development of an individual’s personality through the process of transformation. The
transformation to which Jung refers is a transformation of self, a “coming into selfhood”
or “self-realization“ (p. 266). Jung (1966) defines the self as the individual’s conscious
and unconscious processes that are ultimately responsible for his/her personality,
thoughts, and feelings. Transformation is a step towards psychological wholeness.
Schmidt (2005) described transformation as the process through which an individual
undergoes achieve a more authentic sense of self.
Jung (1935) offered three steps to achieve transformation: confession, elucidation,
and education. According to Corsini and Wedding (2010), confession involves a
recounting of an individual’s personal history. The therapist is a witness to the
individual’s confession of history. Through the therapist’s acceptance and compassion for
the acts heard in confession, the individual is able to release the guilt and shame that have
characterized the individual’s history. Neuroscientist David Eagleman (as cited in Bauer,
2011) stated that the act of confession actually has positive impact on brain function, in
that keeping a secret leads to tension in the brain. Furthermore, Berggren (1975)
35
contended that when an individual confesses he/she gains release from tension and
experiences feelings of relief and joy. The 12 Step Program also facilitates the beneficial
act of confession (Wilson & Smith, 1939).
Jung (1966) believed elucidation revealed the beliefs of the unconscious, which
may be causing dysfunction in the individual’s interactions with the world around
Him/her. Elucidation, as described by Corsini and Wedding (2010), involves the
therapist’s discussion of the dreams the individual experiences during sleep. Elucidation
is a continual drawing out the individual’s past and exploration of how it impacts his/her
current state of being. James (1995) described elucidation as the therapist’s interpretation
about the individual’s past.
Education, according to James (1995), is the point in therapy when the therapist
educates the individual about the aspects of his/her life that are lacking or dysfunctional.
Rychlak (1973) stated that there is no one way to execute the education stage of therapy.
He noted that the education stage may invite the therapist to act as a friend by lending
moral support and encouragement for the individual to alter the dysfunction.
The processes of confession, elucidation, and education evoke a transformation
within the client that results in self-ness. By being aware of one’s self, a person becomes
an observer of how he/she interacts with the world. Jung (1966) believed that what an
individual found distasteful in the world was what he/she found distasteful in
himself/herself. In viewing the world through the lens of self-awareness, an individual
can see the good in society and the positive way society interacts with him/her. In doing
so, an individual can then reflect on the goodness in oneself. When an individual has
achieved self-awareness, he/she becomes self-actualized (1966).
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Maslow (1943) described self-actualized individuals as having a more efficient
perception of reality and a more comfortable relationship with reality, in that the
individual accepts himself/herself, others, and nature. Furthermore, the individual is not
ashamed of or guilty about being human and having shortcomings, nor is he/she critical
of shortcomings in others. Rather, they respect and value themselves and others. The
acceptance of one’s shortcomings comprises an important piece of the 12 Step Program
(Wilson & Smith, 1939).
Jung (1966) saw self-actualization as feeling of wholeness within the self and a
connection with all of humanity. Transformation, self-awareness, and self-actualization
empower the individual by giving him/her a stronger sense of self and how the self
interacts with the world. For Jung, the importance behind the concepts of transformation,
self-awareness, and self-actualization were to connect the human experience to the
spiritual experience (1966).
According to King and Nicol (1999), many individuals today have a perceived
loss of purpose and meaning, leaving them to feel isolated in the world and spiritually
bereft and driving them to embark on spiritual quests. The concepts of transformation,
self-awareness, self-actualization, and a connection to spirituality are large components
of the 12 Step Theory of General Well-Being.
Conclusion
In conclusion, the purpose of this project is to create a theory for wellness in the
mental health field based on the 12 Steps (Wilson & Smith, 1939). The tenets behind
these steps involve the human conditions of spirituality, surrender, facing fears, changing
behavior, inward reflection, responsibility for self-action, humility, and interpersonal
37
awareness. Each step carries the essence of many theories that demonstrate scientific
efficacy and present successful tools for well-being.
The 12 Step Theory for General Well-Being can be a valuable tool to therapists
because it is applicable to diverse cultural population, in addition to incorporating
spirituality as one of its main tenets. The 12 steps have brought about a successful
blueprint for life for millions of people over the 80 past years (Sober Nation, 2014;
Wilson & Smith, 1939). Why, then, limit this gift of mental health to people who suffer
from addiction? The 12 Step Theory for General Well-Being will grant accessibility to
wellness to anyone who wishes to experience mental health through the use of a 12 step
framework.
38
Chapter Three: Developing the Project
This project involved creating a new unified theory for field of mental health that
currently carries the working title of the 12 Step Theory for General Well-Being. This
theory is based on the 12 Step Program originally created by Bill Wilson and Dr. Bob
Smith (1939) to aid in the recovery of suffering alcoholics. By taking an in-depth look at
the 12 step program, it is evident that the 12 steps carry many components of well known
theories currently implemented in the field of psychology. The 12 Step Theory for
General Well-Being will pull tools and concepts from these theories to create a unified
theory for mental health.
Development of Project
The 12 Step Theory for General Well-Being uses the 12 steps designed by Wilson
and Smith (1939) as a skeleton for the new unified theory. I will then use the components
of the previously discussed and respected theories for mental health including, but not
limited to, logotherapy, analytical psychology, and positive psychology to flesh out the
full body of the theory.
Each step in the unified theory will be laid out in the appendix. Each step will
contain information regarding the roots of the step in both 12 step terms and
psychotherapeutic origins; the role of therapist; beginning, middle, and end working
phases of each step; as well as the goals for each step. The project will outline the basics
of treatments plans, addressing issues of gender, age, culture, and diversity.
Intended Audience
The intended audience for this project is professionals in the field of mental
health. Many therapists use the word eclectic when it comes to descriptions of the
39
theories they employ, causing them to pick and choose from different theories. The
unified 12 Step Theory for General Well-Being offers the therapist a theory that
embodies multiple components of theories they know and trust.
Individuals who will find this theory useful are therapists who believe hope and
spirituality play a larger role in the wellness of individual’s than is currently available in
the field of mental health. At present, most theories subscribe to the notion that hope
comprises approximately 10-15% of therapy’s effectiveness (Lambert, 1992). The 12
Step Theory for General Well-Being uses hope and spirituality as key components of its
application. Effective use of the 12 Step Theory for General Well-Being might cause
clients to seek out therapists who employ the unified theory. Users of this theory will
expand upon the theory, not unlike how Jung expanded upon Freud.
Personal Qualifications
It is important for all persons implementing the 12 Step Theory for General WellBeing to be qualified mental health professionals who are capable of navigating the
pitfalls and delicate nuances of taking clients through emotional trauma and resentment.
The therapist must be well versed in the Twelve Steps and Twelve Traditions. A key
factor in the use of this theory will be the therapist’s own personal belief in some form of
Universe/Higher Power. Spirituality is the basis of this theory and can only be
communicated by an individual who can authentically support the theory’s principles.
Environment and Equipment
No specific equipment is required in the use of this theory. The same
environments that would be considered suitable for the predominantly used theories of
40
therapy today, such as a therapist’s office, are perfectly acceptable for implementing the
12 Step Theory of General Well-Being.
The book Twelve Steps and Twelve Traditions is a required text for this work.
Followers of the theory will also need access to paperwork and outlines for the actual
step work involving writing on the client’s part. The various assignments will be
explained and administered to the client by the therapist at appropriate times through out
the treatment process. The client will execute the assignments on their own time, and
return to the therapist for processing and application.
Project Outline
*Overview of the 12 Step Theory for General Well-Being
*Origin of the 12 Step Program
*Diversity concerns
*Description of the therapeutic relationship
*Key steps of the theory
*Goals for different stages of the therapy
*Interventions used during different stages of the therapy
*Maintenance steps and termination of therapy
41
Chapter Four: Project Overview
Summary of Project
The following project is a theory for psychology based on the original 12 Step
Program for Alcoholics, originally created by Bill Wilson and Dr. Bob Smith (1939). The
project has the working title of The 12 Step Theory for General Well-Being. The creation
and need for this theory is based on the seeming lack of theories for psychology based on
spirituality. This project guides the client through the application of a spiritual approach
to life. The theory helps the individual achieve or deepen a spiritual connection to the
Universe or a Higher Power that will guide him/her through all of life’s trials and
tribulations.
When examined closely, the original 12 Step Program embodies the tenets of
many well known theories, with ideas that stem from Jung, Frankl, Seligman, and Freud,
to name a few. The purpose of this project is to create access to a therapy, encompassing
many effective schools of thought for mental health into one unified theory.
Recommendations for Implementation
This theory may be implemented by therapists, counselors, and social workers,
who seek a spiritual approach to helping their clients achieve mental health. The
following is a plan of treatment for dysfunctions such as, but not limited to, anxiety,
depression, self-esteem, anger, relationship issues, work stressors, and spiritual
bankruptcy.
This theory can be implemented with diverse populations from both
individualistic and collectivistic cultures. Professionals in the mental health may find this
theory less limiting than current theories that are available, and less difficult to apply
42
when working with cultures that do not ascribe to the traditional constructs associated
with the mental health field. Although this theory has systemic effects on people in the
individual’s life, it relies only on the individual to assert change within the system in
which he/she operates. This approach should be done in a therapeutic setting, i.e.
therapist office or clinic. One possible limitation of the 12 Step Theory for General WellBeing is that it does not supply the support and egalitarian community that AA offers at
its meetings. People seeking 12 Step help in private practice will be lacking this form of
group support, which is a beneficial aspect of the 12 Step model. However, it should be
noted that the original application of the 12 Step Program was one alcoholic speaking to
another, which eventually evolved into a group dynamic. Therefore, when therapists
choose to use the 12 Step Theory for General Well-Being, they should be well-versed in
the 12 Step model, subscribe to its tenets, and consider engaging in more self disclosure
to bring in the healing aspects of one on one sharing and identification that 12 Step
meetings offer. Additionally, therapists could recommend that clients also participate in
Al-Anon meetings (a sister program to AA) as an adjunct to individual treatment using
this model.
Recommendations for Future Research
Based on research done to create this project, awareness of spirituality as an key
component for mental health seems to be on the rise. Studies have measured the profound
effects that faith, hope, and the belief in some type of Higher Power have on the
achievement of mental wellness. As cited earlier, researchers are challenging the mental
health professionals to address the need for spirituality in therapy.
43
Although this theory attempts to fill the need for a spiritual approach to therapy,
other applications of spirituality with a basis in psychological theories should be
encouraged and nurtured by mental health professionals. Mental and physical health care
providers should work together to further research on the impact of such implementations
on the physical body itself, in hopes of gaining momentum and attracting other mental
health professional to take the strengths of spirituality more seriously.
Perhaps with success of this theory, a step book based solely on the 12 Step
Theory for General Well-Being can be written. A book using terminology that strictly
applies to the theory will create an opportunity for the client to identify more easily with
the literature.
Conclusion
In conclusion, it is my hope to offer a theory to anyone seeking professional
mental health a process that for myself has been transformative. At one time in my life I
suffered from terrible anxiety, depression, self-loathing and defeat. While I had achieved
success at anything I set my mind to, inside I felt bankrupt. I even suffered a heart attack
at the age of 37. The way I chose to cope with the state of being my life had taken on was
substance abuse. While at the time it seemed like a curse, today I am grateful for the path
I had to take to deliver me to the life I am blessed to lead today.
As I have traveled the road of recovery over the last decade, I have had the
pleasure of watching others who suffered as I did transform themselves. They regained
self-esteem, careers, repaired marriages, got their children back, etc.; the list goes on. Just
like them, my family was amazed at my transformation. Through my participation in the
44
program, I have been able to give my family tools to better navigate their own lives that
they were unable to find on their own.
I began to explore psychology and searched out a career in the mental health field.
As I studied various psychological theories, it became apparent to me that hope and faith,
while a part of most theories, comprised a very small part of therapy. Surely faith played
a bigger part than the recognized 10-15% commonly attributed to well being in the field
of psychology, since faith and hope played a starring role in my recovery.
I began to question why these transformative steps should be limited to people
who suffer from addictions. Why shouldn’t the 12 steps be available to anyone seeking,
as Wilson and Smith (1939) call it, a “happy road to destiny” (p. 164)? Why couldn’t I
try and devise a theory for psychology based on the original 12 Steps?
As I set out on this quest, I realized the reason why these steps may be so
transformative is that they contain the wisdom of centuries of psychologists who had
come before me. Jung, Frankl, Freud, Seligman, Ellis, Satir; all of their knowledge could
be found within the 12 steps. The only difference was, by some fortuity, Wilson and
Smith managed to put them all together with out even knowing it. The unified theory laid
out subsequently bears the gift of embodying all of these transformative processes and
beliefs into one theory.
It is my hope that the execution of this theory will bring joy and freedom to those
who now only feel anxiety and sadness: people who do not realize they are not just little
drops of water sprayed out from a great ocean. When connected to the Universe or
Higher Power, they may realize they have the strength of the whole ocean inside of them.
I hope the theory brings self-love where there is self-loathing, acceptance where there is
45
hatred, and faith where this is fear. For all these reasons and more, I hope this theory
offers a tiny drop of strength in the field of psychology that brings the magnitude of the
ocean.
46
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57
Appendix: Project
THE 12 STEP THEORY FOR GENERAL WELL-BEING
“A design for living, that works in rough going.” -Wilson & Smith, 1939, p. 15
The Heart
The 12 Step Theory for General Well-Being is based on the 12 Steps of
Alcoholics Anonymous (Wilson & Smith, 1939). Bill Wilson and Bob Smith (1939)
created this 12 Step program to help alcoholics recover from the disease of alcoholism.
To the astonishment of the medical community and even the alcoholics themselves, these
12 Steps proved to be transformational: not only to the alcoholic, but also for the
families, friends, and communities of the alcoholic. Today there are over 2,000 programs
based on the 12 Step Program to help individuals recover from myriad compulsions, i.e.,
food, gambling, sex, shopping, to name a few. Alcoholics Anonymous (2001), which is
the basic text for the 12 Step Program is, to date, printed in 41 languages; therefore it can
be applicable to a wide range of individuals with many different cultural backgrounds.
The 12 Step Program is a spiritual one. In this author’s opinion, Wilson and Smith
did not figure out the alcoholic, they figured out human nature; what makes people angry,
resentful, and self-loathing, and, in contrast, what makes us feel productive, empathetic,
loved, and connected. It is for this reason I have created The 12 Step Theory for General
Well-Being. Why limit this transformational program to those who have hit a bottom as a
result of addiction? Why not grant access to this design for living to those who seek to
overcome mental health issues, such as, but not limited to, anxiety, depression, anger, and
low self-esteem?
58
When examined closely, the original 12 Steps carry the tenets of many wellrespected and effective theories. The voices of Frankl, Jung, Seligman, Ellis, Rogers, and
even Freud echo throughout the application of the 12 Steps. The purpose of this project is
to create a unified theory. In the following pages, I will present the layout of a spiritual
theory for good mental health.
The Soul
The 12 Step Theory for General Well-Being is a spiritually based process that
requires therapists to work from a spiritual perspective. The 12 Step approach has a broad
spectrum regarding its definition of what spirituality is; therefore, it is accessible to a
wide range of diverse individuals from different, races, cultures, religions, and belief
systems, including atheists and agnostics. However, while it is essential the therapist have
a strong spiritual base, many individuals in need of this type of therapy are spiritually
bankrupt and may not have any connection to a Universe/Higher Power. This should not
be a deterrent for the therapist; it is in fact the soul of the 12 Step Theory for General
Well-Being. Through the application of therapy, the individual will find and thrive in
spirituality. Therapists must hold a broad view in regard to the individual’s choice and or
limitations in his/her concept of a Universe/Higher Power. The individual relies on the
therapist and the tools of the theory to create or increase his/her spiritual connection.
The Spirit
What is God or a higher power? No one, not even the therapist, can determine this
concept for the individual. For the purpose of being inclusive to all spiritual schools of
thought, the 12 Step Theory for General Well-Being will use the terms Universe or
59
Higher Power. These terms can refer to any source of spiritual belief, be it God, Buddha,
Allah, Jesus, or the power of nature itself.
The steps will guide the therapist and the client together to define and develop the
individual’s spiritual connection. The purpose of developing a spiritual connection is help
the individual gain meaning in the circumstances of his/her life. Pervasive symptoms in
individuals seeking therapy include depression, anxiety, resentment, fear, and aggression.
Many individuals experience a diminished sense of self and feel powerless over the cards
life has dealt them. The spiritual connection becomes a coping mechanism for the
individual to see his/her part in life’s situations, and gives the individual faith and
strength to overcome life’s obstacles and grow in the process. The process facilitates the
individual’s ability to experience life differently than he/she did before therapy. Ideally,
he/she emerges from the therapeutic process feeling empowered and loved by
himself/herself, with a sense of purpose in the world.
The Backbone
Therapists aiding individuals with the 12 Step Theory for General Well-Being
will take their clients through the 12 Steps as they are laid out in this theory. The theory
provides a clear and concise guideline for the therapist to help individuals connect with a
Universe/Higher Power, see patterns in dysfunctional behaviors, identify fears,
acknowledge and remove defects of character, mend relationships, and employ daily
maintenance after therapy has terminated.
The Hand
The therapeutic relationship is of utmost importance in the 12 Step Theory of
General Well-Being. Much like Carl Rogers (1961), the therapist views the client with
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unconditional positive regard. The journey of finding a spiritual connection is a personal
one, and it is important the individual feels trust, faith, warmth, empathy, and guidance in
the therapeutic alliance. Until the individual is able to attain a relationship with his/her
Universe/Higher Power, the faith the therapist holds in the process, as well as the client
himself/herself, will be a determining factor in the success of the theory.
The Needs
The basic text supporting the 12 Step Theory for General Well-Being is the book
Twelve Steps and Twelve Traditions by Alcoholics Anonymous. This publication is
available on Amazon.com and in recovery oriented stores. It is essential that the therapist
be thoroughly familiar with the contents of this book in order to be skilled in facilitating
the application of the steps with the client.
In addition to the book, it is recommended that the client find a blank journal or
notebook in which to enter all of his/her step work. Please also find attached to the end of
this project a Step Four Worksheet to be used as a template for the assignment in Step
Four.
***Important note: When reading the text with the client, the therapist MUST
explain the broad reach offered by 12 Step Programs, and help the client to replace
the following words and phrases, either mentally or in pen.
•
“Alcohol” is replaced by “people, places and things”
•
“Alcoholic/AA/drinker “ is replaced by “client/patient”
•
“Sponsor” is replaced by “therapist”
•
“AA” is replaced by “the program for therapy”
•
Drink/drinking is replaced by think/thinking
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•
God is replaced by the Universe or Higher Power
It is vital that the therapist be adept at framing the client’s issues outside of alcoholic
terminology in order for the client to identify with the material. In AA, this is done
successfully by sponsors who work with addictions other than alcohol, such as food,
gambling, sex etc.,
The Steps
Step One: “I admit I am powerless over people, places and things, and my
life has become unmanageable.” In step one the therapist and client began therapy by
identifying feelings and symptoms that the client has experienced, causing him/her client
to seek therapy. Perhaps the individual is discontented or pained about his/her spouse,
children, work situations, or even extreme sickness like cancer. Maybe the client feels
forsaken, helpless, or misunderstood, leading him/her to feel anxiety, depression, or anger
due to the lack of control he/she is experiencing in the world around him/her. These
situations are examples of powerlessness and unmanageability.
Powerlessness and unmanageability are often catalysts for depression, anxiety,
fear, resentment, and anger. It is important that the therapist and the client together
connect the symptoms to the experiences the client perceives is causing them. Quite often
clients feel as if they are unique in their experiences, thinking “Why are these things
always happening to me?” Although the events are, of course, personal to the client, the
opportunity to normalize these feelings is an integral part of step one.
Once the therapist and client have identified the circumstances that have led the
client to therapy (one to two sessions), the therapist and the client together commence the
steps by reading step one in Twelve Steps and Twelve Traditions. During the reading, the
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therapist should encourage the client to highlight or underline sentences/words with
which he/she identifies, and take the time to discuss why that particular phrase or word
stood out to him/her.
As the client begins to identify with the reading he/she usually experiences an
immediate sense of relief in knowing that others have felt the same way. The client
senses a feeling of hope when reading that others may have recovered from the feelings
that are currently bringing the client such despair. The reading should help to normalize
the client’s experiences and further tie the unmanageability to the futile desire for control
and the symptoms the attempt for control produces.
10 events. After the reading is finished the therapist proceeds to the step one
assignment. The assignment is to outline, in his/her notebook, 10 events in which the
client has tried to control a person, place, or thing only to experience frustration, hurt, and
defeat. The client will identify the events and list the consequences that were wrought on
himself/herself both emotionally and physically as a result of attempting control. In
addition, the client will list the consequences experienced emotionally and physically by
others.
Example:
Event # 1-What I wanted to happen: “I wanted my father to take better care of
himself, I was begging him all through dinner to make better choices about his
food intake. I hoped he would just listen to me and pick healthy food, and he
would feel better about himself and ultimately live longer.”
What actually happened: “We ended up having a big fight, he got mad at me
and ordered what he wanted anyway.”
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Consequences to Self (Physically): “ My stomach hurt, I could feel my blood
pressure go up, and I couldn’t finish dinner.”
Consequences to Self (Emotional): “I felt angry, scared, anxious, and depressed.
I felt like if he loved me, he would take better care of himself.”
Consequences to Others (Physical): “My father didn’t enjoy his dinner. We
probably held up the waiter. Other’s had to wait for their food while the waiter
spent extra time at our table.”
Consequences to Others (Emotional): “My father felt angry, infantilized,
judged and shamed by his daughter. The waiter was annoyed. Other customers
were angry.”
The assignment is done at home, outside of the therapeutic setting. The client
reads the events aloud to the therapist in the following session. In reading the assignment,
the client and the therapist are given a clearer understanding about the attempts at control
the client has experienced thus far, along with the dysfunctional feelings and behaviors
that accompany them.
Step two: “Came to believe that a power greater than myself could restore
me to sanity.” Step two embodies the paradox of surrender to win. The purpose of step
two is to help the client realize that, so far, no human power has changed his/her need to
control people, places, and things. Despite past attempts to cease the to control,
ultimately the client feels his/her way is the best way, leading the individual, once again,
to engage in dysfunctional behavior, accompanied by feelings of hurt and futility. Or,
maybe the client did not realize his/her need for control even existed until coming to the
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therapy. The recognition of the difficulties a need for control create may have just been
brought to light for the first time.
To commence step two, the client and therapist together read step two in Twelve
Steps and Twelve Traditions. Throughout each reading the client should be encouraged to
highlight meaningful sentences or words and share their significance with the therapist.
The client and therapist then explore the individual’s feelings about the Universe/Higher
Power.
The literature defines four types of thoughts on belief in The Universe or a Higher
Power. The first type is a person who was once a believer but has lost faith. The second is
a person who does not believe a Higher Power exists at all. The third is person who does
not know if Higher Power exists, and lastly there is the person who does believe in a
Higher Power, but feels a Higher Power has lost faith or forsaken in him/her.
If the client truly struggles to connect with any idea of a Universe/Higher Power,
it may be helpful to guide the client toward thoughts of nature. Nature has proven itself to
be a life sustaining power that humans do not exceed in regard to strength or power. If
nature does not work, merely the power of the 12 Step Program and its impact on others
can serve as the high power itself. Sometimes mere hope that there might be a Higher
Power is strength enough. The literature will help provide a grasp on a Higher Power,
however small it may be at this point in therapy.
Moment of insanity/clarity. Proceed now to the step two assignment. This
assignment asks the client to write two separate entries in his/her notebook. The first
entry describes his/her most frustrating and futile attempt at control. Since step two
promises the individual a return to sanity, this entry should represent a moment of
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insanity, a vain and pointless attempt at control. The second entry describes a moment of
clarity: a moment when the client saw the attempt at control would be unfruitful, and
instead chose to step out of the proverbial driver’s seat.
This work is completed outside of the therapeutic setting, and read to the therapist
in the next session. The moment of clarity provides a foothold for the client, that he/she
does have sense of how his/her behavior regarding control is of no avail. Furthermore, the
notion that he/she may be led to more helpful behavior provides hope to the client for a
chance at different life experiences in the future.
Example:
Moment of Insanity (1-3 paragraphs): Client writes out a detailed account of
the need to control the person who is driving in front of him/her on the freeway.
Ending up in aggressive behavior and a ticket for the client.
Moment of Clarity (1-3 paragraphs): Client writes out a detailed account of
being cut off in traffic and just continuing on his/her day without taking it
personally or vilifying the driver in question.
Step three: “Made a decision to turn my will and my life over to the
Universe/Higher Power, as I understand It.” The therapist and client will read step
three together. The idea of turning one’s will and life over to anything sounds frightening
and impossible to most. The idea of releasing control may cause the client to recoil. At
this time, the therapist may need to remind the client of the unmanageability experienced
by the client when trying to maintain control in the past, as evidenced by the work done
in step one.
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It is important to point out the word care in step three. This is a decision to one’s
will and life over to the care of the Universe/Higher Power. The individual will be taken
care of. This step is to instill trust in the client in a force that is benevolent, not
judgmental or cruel.
The therapist will now explore with the client what his/her Higher Power looks
like to him/her. What qualities would the client like this Higher Power to embody? How
would the client like to be cared for if it were possible? The therapist should encourage
the concept of a benevolent force. It may be difficult for the client to feel deserving of
unconditional love and guidance in this stage of therapy.
This is why it is important for the therapist to believe in and feel a positive
connection with his/her own Higher Power. The therapist must have the belief that he/she
can trust the Universe or his/her Higher Power absolutely. The therapist’s experience
with spirituality may be the only stronghold the client is able to build on at this time. The
therapist’s belief and trust in the Universe/Higher Power drives the application of this
form of therapy.
A prayer to the Universe/Higher power. The therapist now asks the client to write
a prayer to the Universe or his/her Higher Power before the next session. This prayer will
consist of the kind of care and guidance the client wants from the Universe/Higher
Power. This prayer should be memorized and recited either aloud or inwardly by the
client whenever seeking guidance.
The client has now begun the process of having conscious contact with the
Universe or his/her Higher Power. The therapist encourages the client to have ongoing
communication with the force over to which he/she has now turned his/her will and life.
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This process teaches the client to pause before reacting to explosive situations, or
situations that in the past have proved difficult for him/her. A conscious contact with the
Universe/Higher Power means the individual no longer feels alone in the world. When
faced with difficulties the client is to prevent himself/herself from engaging in erratic
emotional reactions. Instead, he/she goes to the Universe/Higher Power to help guide
his/her actions.
The relationship between the client and the Universe/Higher Power is in its
infancy. Step three’s second half states “...as I understand It.” The client’s understanding
of the Universe/Higher Power may be elementary at this point in therapy. Just like a child
who must learn one letter of the alphabet at a time before he/she is able to make words
and eventually read epic novels, the client’s understanding of the Universe/Higher Power
will grow. However, this takes practice. The client now begins to practice having a
relationship the Universe/Higher Power. He/she endeavors to engage in communication
with the force that guides him/her.
Below is a sample of the third step prayer seen in Alcoholics Anonymous, but is
recommended the client create a prayer that is personal to him/her.
I offer myself to Thee — to build with me and to do with me as Thou wilt.
Relieve me of the bondage of self, that I may better do Thy will. Take away my
difficulties, that victory over them may bear witness to those I would help of Thy
Power, Thy Love, and Thy Way of life. May I do Thy will always! (Alcoholics
Anonymous, 1939, p. 63).
Step four: “Made a searching and fearless moral inventory of myself.” Step
four is a key component in the 12 Step Theory for Well-Being in helping the client to
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identify the source of the symptoms that have brought him/her to therapy. This process
may take 1-2 months, depending on the client’s willingness to dig deeply into his/her
past.
The purpose of this step is to find the root cause of life’s resentments, the part the
individual played in the resentments, and fear behind the resentments. The client must be
fearless and thorough in this step, leaving no stone unturned. This includes every deep
dark secret the client has kept to himself/herself through the years. As has been done with
each previous step, the therapist and client begin by reading step four in Twelve Steps and
Twelve Traditions, highlighting and discussing as they go. After the reading, the therapist
explains the depth of the inventory assignment that lies ahead.
Step four inventory. The inventory is done outside of the therapeutic setting, and
it is likely the client will experience a lot of emotional upheaval throughout this process,
causing him/her to express discomfort and hesitation about doing the assignment. During
this part of therapy the therapist should help the client stay connected to his/her Higher
Power, trust in the therapy, and continue the work, however painful it may be. Clients
may drag their feet on this one.
The step four inventory is as follows: The client will begin the writing by going
back to the earliest age in his/her memory and moving up to the present listing every
single resentment the client can recall. This may sound unreasonable or perhaps
impossible, but it has been done by millions of people who have found the curative
results of this grueling inventory to be nothing short of a miracle.
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Example:
Age Person/Place/Thing
Resentment
4
my brother
Getting me in
trouble for
crossing the street
when I shouldn’t
have
My Part
Fear
I crossed the Being
street
abandoned/he
didn’t love me
If the client is having trouble remembering his/her earliest resentment, the
inventory may be done in reverse, starting at present day and working backwards. There
may be instances throughout the process when the client is having trouble identifying
his/her part in the resentment. For instance, what is a child’s part in a parent’s divorce?
We all have a part in every situation. In the case of the parent’s divorce, perhaps the child
has carried the belief that it was his/her fault, or the belief that it was personal to the
client, and not about his/her parents.
It is important to remember that the client should include resentments he/she may
have towards himself/herself.
Example:
Age Person/Place/Thing
Resentment
35
Self
Hating myself
My Part
I cheated
on my
husband
Fear
He didn’t love
me/abandonment/not
being enough
In this process, the client will learn to identify the fears that are defended,
masked, and blocked by anger. Resentments take up tremendous space in the psyche, so
much so that they can block positive feelings. I recall an individual with whom I worked
whose mother made up a good deal of her inventory. After having released all the anger
for her mother onto paper, she felt an overwhelming feeling of love for her mother on
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their next encounter, seemingly out of nowhere. By releasing the anger, there was room
for love.
The healing process of the fourth step inventory makes room for love and
compassion where there once was anger and hurt. This is true not only about feelings of
compassion for others, but also for feelings love and compassion for the self. After the
fourth step the therapist should encourage the client to cease negative self-talk and begin
addressing himself/herself more lovingly. Speaking kindly to oneself is an important part
of the transformation in the 12 Step Theory for General Well-Being.
Step five: “Admitted to the Universe/Higher Power, to myself, and another
human being the exact nature of my wrongs.” Step five is simple and powerful. It is
similar in some ways to the act of confession. Through the years confession has been
shown to be a reliever of guilt and shame the individual has been carrying. Step five is
done in the therapy room. After reading step five in the Twelve Steps and Twelve
Traditions, the client quite simply reads his/her fourth step to the therapist just as it is
written on the paper.
The therapeutic alliance is vital during this step. The therapist must be very
careful not to shame the client, not matter how dark the subject matter. One of the
essential points of this step is to remove guilt and shame through the corrective emotional
experience of compassion given to the client by the therapist. It is a chance to empathize
with the client’s pain and fear, and help him/her recognize the behaviors and thoughts
that once may have served as protection are no longer functional or healthy. Individuals
have described feeling a tremendous weight lifted off of their shoulders after reading the
inventory.
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The fourth step inventory will reveal a pattern of fears that have operated
throughout the client’s life from the beginning. This often comes as a surprise to the
client, and can help both the client and therapist navigate future pitfalls by recognizing
the dysfunctional patterns of past, repetitive behavior and fear.
Step six: “I am entirely ready to have the Universe/Higher remove all these
defects of character.” At this point in treatment, the client has released the need to
control people, places, and things. Trusting the therapy and following the
Universe/Higher Power’s will, the client can see the detriment in the desire to control the
world around him/her. He/she sees control has not helped, but only hindered his/her life.
Furthermore, in step four the client brought to light all of his/her dysfunctional behaviors.
The client is now ready to embark on the journey of releasing the behaviors that no
longer serve him/her.
Defects of character. Once again, the therapist and client read together out of the
Twelve Steps and Twelve Traditions, commencing now with step six. After finishing the
reading and exploring the material discussed in chapter six, the client goes home to make
a list in his/her journal. The client lists all the defects of character that have been
illuminated in step four, i.e., infidelity, gluttony, laziness, belligerence, vanity,
dishonesty, jealousy, gluttony, negative self-talk, judgment of self, and others, etc. The
therapist should remind the client the importance of being thorough. It is important to
stress that these defects of character do not represent shame, but in fact it is through the
love and acceptance of self that the client will be able to shed these defects.
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The client then returns to therapy and shares his/her defects aloud with the
therapist. At this point, the client may look to the therapist to question just how these
defects of character will be removed. The answer is found in step seven.
Step seven: “Humbly asked the Universe/Higher Power to remove my
shortcomings.” At this stage of therapy, the client has developed a conscious contact
with the Universe/Higher Power. The client is able to look inward to his/her higher self
and intuitively understand situations that used to elude him/her. The individual has
identified his/her defects of character and no longer wishes to participate in behavior that
does not serve him/her.
The therapist should be clear that the removal of shortcomings does not happen in
the wave of a wand, nor is the client responsible for the removal of shortcomings. Rather,
the client leaves this to the Universe/Higher Power. Some defects disappear very quickly,
some defects seem to dissipate illusively over time as the individual continues to grow
and heal through the rest of the journey in therapy.
I recall an individual with whom I once worked who struggled for years to put her
laundry away when she was done washing her clothes rather than leaving them in a pile
on a chair. She called me several months after our work together was done to share the
fact that the other morning she looked in closet and realized she had unwittingly been
putting her clothes away for months, and they were even color coordinated. She
exclaimed “I don’t even remember it happening, it was like I opened the closet door one
day and pow...I realized what had happened!”
The Universe Box/Higher Power Box. The assignment for step seven is an art
project. The client will make a “Universe Box or Higher Power Box.” The box can be
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very simple or highly decorated, depending on the client’s inclinations. Each time the
client is experiencing dysfunctional behavior, he/she writes the related character defect
on a piece of paper, puts it in the Universe Box/Higher Power and releases the selfimposed burden to change the behavior himself/herself.
The seventh step prayer found in the AA literature is a useful tool for the client
when trying to give the defects of character that have plagued him/her in the past to
his/her Universe/Higher Power. It reads as follows:
My Creator, I am now willing that you should have all of me, good and bad. I
pray that you now remove from me every single defect of character, which stands
in the way of my usefulness to you and my fellows. Grant me strength, as I go out
from here to do Your bidding. (Alcoholics Anonymous, 1939 p. 63)
When facing situations that are reminiscent of past behavior, the individual looks to the
Universe/Higher Power to give him/her strength and guidance as to how to behave
differently, thereby producing a different outcome.
Step eight: “Made a list of all persons I have harmed, and became willing to
make amends to them all.” Steps eight and nine are the final pieces aiding the client in
ridding himself/herself from guilt and shame. They are the final steps to freedom from
the past. The therapist may find resistance and fear in the client at the thought of making
amends to people by which they still feel wronged. The therapist must point out that steps
eight and nine are not about saying, “It’s okay that you stepped on my toes;” they are
about saying, “I’m sorry that I stepped on your toes.” Step four has already revealed the
part the individual has played in each and every resentment; steps eight and nine are
about reconciling that part.
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The amends list. Step eight is merely the making of a list. To commence step
eight the therapist and client do the reading pertaining to the step as usual. The therapist
then helps the client go back through the step four inventory to select the people who are
in need of amends. This list is not limited to the information on the step four inventory.
The client may add to this list any person, place, or thing that is in need of amends. For
example, perhaps the client has stolen something from a store. The store should be on the
list. The client can go and make restitution for what he/she has taken, availing him/her of
a free conscience. Maybe the client has ruined many family dinners with his/her
depression by inflicting his/her mood on the family. These family members should be on
the list. Always encourage your client to be fearless in making this list. An amends may
not always be in order, but it is important to bring attention to all possibilities. The
purpose of making this list is to identify what brings the client shame and guilt.
By this time, if the work has been done thoroughly, the client is keeping no
further secrets from the therapist. The therapist must always treat the client with
compassion, never shaming or judging him/her. This may sound self-explanatory in a
therapeutic setting, but maintaining empathy and focusing on the individual’s strength to
right the past is crucial.
Step nine: “Made direct amends to such people wherever possible, except
when to do so would injure them or others.” Read step nine in The Twelve Steps and
Twelve Traditions with the client. Together the therapist and client will put the amends
list in order. It is recommended to start with the easy ones, putting those at the top of list.
This gives the client a sense of ease about the process.
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Remove the amends that can do harm to others, i.e., if the client had an affair with
her best friend’s husband, telling the friend could do serious damage to her marriage and
cause more damage than repair. While it may ease guilt for the client, it is important to
remind the client that the amends process is not only about the individual, it is about
righting wrongs and creating harmony where there was once discord.
Make sure the client puts himself/herself on the amends list. Asking for
forgiveness of self is crucial and curative. All of the resentments the client has listed
toward the self on the step four inventory should be forgiven by him/her in step nine.
Making amends. The therapist and the client discuss what will be said in the
amends. Clinical judgment from the therapist is helpful in planning the amends to ensure
the client does not get reinjured in the process of making amends. The amends should be
born out of humility and stated in terms of strength, acceptance, and recognition of
wrongdoings. The amends is not an exercise of flogging oneself to others in hope of
receiving forgiveness.
It is fine if the client would like to write down the amends and read from his/her
notes while making his/her amends. However, writing down the amends word for word
may not be necessary for some. It is recommended that an amends be made in person,
whenever possible.
The therapist should prepare the client not to have any expectations in regard to
others’ response to the amends. The response received in making the amends is not the
individual’s choice. Rather, it is done without any expectations on the part of the person
receiving the amends. In keeping with the philosophy of the steps, the individual cannot
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control the person to whom he/she is apologizing. Rather, the amends itself is the curative
factor, not the response.
Ironically, the responses the individual fears most tend to be the most palatable,
and the amends the client thinks will be easy may surprise him/her and prove to be
somewhat uncomfortable. It is important for the individual to simply listen to the
response without letting the discussion become another rupture for the relationship in
question. Remember, it is not the response to the amends that is curative, but the act of
making the amends itself.
Occasionally, the person receiving the amends did not perceive a rupture in the
first place, but may express a time when he/she did feel injured by the client. The client
should also listen to these recollections with an open ear, and amended on the spot if
appropriate. If the client is not sure how to respond to the new accusations, he/she should
take in the information without reacting in the moment and discuss the new information
with the therapist to determine if an amends is indeed necessary. More often than not, the
client will feel tremendous strength and relief upon finishing each amends, empowering
him/her to complete the list made in step eight.
Step Ten: “Continued to take a personal inventory, and when I was wrong
promptly admitted it.” The client and therapist together read Step ten in Twelve Steps
and Twelve Traditions. Step ten is a maintenance step. The client has just rid
himself/herself of any guilt for participation in wrong doings in the past; however, it
would be irrational to think he/she will never step on anyone’s toes in the future. Step ten
gives the client a tool to address transgressions of this type in the moment, or, if not,
shortly thereafter.
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No longer driven by pride, the client uses step ten to remain on a path of
acceptance and compassion. He/she has experienced the relief of admitting a wrongdoing
and the freedom that follows. This is not to say that one jumps for joy at the chance to
admit one’s mistakes or transgressions. Rather, it is method for maintaining a clear
conscience that is free of shame and guilt.
Step ten will be useful to the client long after therapy has been terminated. It is a
tool that will help him/her sustain the mental health achieved in treatment. The point of
the 12 Step Theory for General Well-Being is to teach client skills that will help them
navigate the inevitable pitfalls life sometimes offers.
Step Eleven: “Sought through prayer and meditation to improve my
conscious contact with the Universe/Higher Power, as I understand It, praying only
for the knowledge of It’s will for me and the power to carry that out.” Step eleven,
like step ten, is a maintenance step. His/her conscious contact with the Universe/Higher
Power should never remain stagnant. Earlier on, in steps three and seven, the client began
his/her conscious contact with the Universe/Higher Power. By now the relationship has
deepened, and the client’s understanding of the Universe/Higher Power is no longer in its
infancy; the client has now gained trust in the Universe/Higher Power.
By turning his/her will over to the care of the Universe/Higher Power, the client
has identified thoughts and behaviors that did not serve him/her and received guidance on
how to change them. He/she has shared his/her darkest secrets and was not judged or
shamed. He/she has learned to accept himself/herself, achieving a feeling of authenticity.
He/she has mended relationships and situations that wrought discord. He/she has gained
tools to maintain harmony in life’s day-to-day trials and tribulations. After reading step
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eleven with the client in Twelve Steps and Twelve Traditions, daily prayer and meditation
are introduced.
Daily prayer and meditation. If the client has not already done so on his/her own,
the therapist should recommend incorporating daily prayer and meditation. Meditation is
suggested as a morning routine. Creating a morning routine that starts the day with
serenity and inner peace allows the client to face the day with a well-nourished spirit. It
has been said that breakfast is the most important meal of the day, as it provides the
energy that fuels the body after a long night’s sleep without sustenance. Meditation
provides sustenance for the spirit after a long night with the subconscious!
The night has been spent asleep and the subconscious been processing issues of
the day, fears, and worries. Of course, people have good dreams as well. Starting the
morning with mediation and prayer allows the individual to start the day fresh. Brushing
one’s teeth leaves one’s mouth feeling fresh. Meditation is like brushing the soul, leaving
the soul feeling refreshed and restored.
Meditation is not relegated to the morning only. Just as brushing one’s teeth after
a garlic-filled meal can restore freshness, mediation can freshen the spirit after unpleasant
encounters throughout the day.
It is important that the client has incorporated the practice of prayer and
meditation before terminating therapy. If the therapist is skilled at meditation, the
therapist may do guided meditations with the client or teach meditation techniques to the
client in order to get him/her started. Many books and audio recordings are available to
help guide clients with basic meditation practice. Encourage the client to explore
different types of material to find the one that works for him/her.
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Step 12: “Having had a spiritual awakening as the result of these Steps, I will
try to carry this message, and to practice these principles in all my affairs.” Step 12
embodies the sayings Be the change you want to see in the world or Pay it forward. As
the client and the therapist enter the termination phase of therapy, for the last time they
will sit and read out of Twelve Steps and Twelve Traditions. Step 12 opens by stating,
“The joy of living is the twelfth step and action is its key word” (Wilson & Smith, 1952,
p. 106).
The client has had a spiritual awakening by being granted a new way of thinking
and a new way of interacting with the world around him/her. He/she is experiencing new
levels of honesty, peace of mind, compassion for others, and love of self that may have
seemed out of reach before the start of therapy.
He/she now prepares to leave therapy with a set of tools that work in all of life’s
circumstances. He/she has a “design for living, which works in rough going” (Wilson &
Smith, 1939, p. 14).
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