“And yet it seems to me that the process itself, in its very commitment to interiority — its attempt to ferret out prime causes and pivotal events from the psychic rubble of the past and the unwieldy conflicts of the present — can be intriguing enough to stand in as its own reward.”

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[This is a doozy of an article: long-winded, self-involved, not entirely pleasant to read. The obligatory horror stories of pathologically insensitive therapists make me cringe; I believe them but feel they're sensationalized and unbalanced. With the utmost sympathy, Daphne Merkin does seem like a person destined for therapy. I don't mean this as an insult – I wouldn't be featuring this article if I did. (I wouldn't be here if I did!) Merkin's struggles are real, and she's honest about them. As a result, she doesn't offer up the most likable self-portrait. I don't know if that's her objective, but in any case she bravely illustrates a core tenant of therapy: we evade the truth of ourselves at extremely high cost. If you read this article, read it with an open mind. Daphne Merkin may not be "your kind of person," but the sympathy that she feels for herself in the face of obviously frustrating emotions is, I'm sure, a consequence of her life in therapy – a consequence and a great accomplishment. -Ed.]

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[I have a friend in medical school – a psychiatrist in training – who tells me that AA gets tremendous credit for being the most effective addiction recovery program in existence. This surprised me, because a) I didn't know that AA's success rate is the gold standard, and b) I thought that many of AA's strategies were at odds with certain classic, psycho-therapuetic mores. The latter appears to be true, although this article suggests a welcome shift in attitude. If AA offers the best chance for recovery, than psychotherapy should follow its lead. Therapists, say the authors, should break out of their comfort zones when the failure of addiction looms; the successful treatment of alcoholism may require more communion with patients than is commonly advised.

This makes a lot of sense to me. In my own treatment (not for addiction, admittedly), my therapist never shared her own stories. I knew next to nothing about her life, and I assumed it would stay that way. But in one instance, she shattered this well-established practice – it was shocking to both of us – by sharing an incredibly intimate story about a death in her family. I could see this made her nervous. Clearly she was going out on a limb, defying her own notion of "best practices." Yet her intuition paid off. Her story changed my life, not because it made me feel any closer to her, but because it made me feel closer to others (certain others at first, and then more generally). I went from feeling confused and frustrated to feeling sympathetic and forgiving.

She told me her story, she said later, in an attempt to give me facts that she never thought I'd get, i.e. I wanted explanations from people who couldn't give them to me. The revelation of her family's secret became a stand-in for the experience I'd been missing, both literally – she told me something I never thought I'd hear – and figuratively – her story gave shape to the actions of people in my own life. She drew a parallel, but she also broke a boundary. Both helped my treatment; I can't say which helped more. This is the art of psychotherapy: the acknowledgment that, despite an appropriately clinical approach, any rules-based system is bound to fall short in the face of us. -Ed.]

Several countries have trialled the prescription of heroin itself, with, it turns out, a great deal of success – including better health, a reduction in criminal activity and a higher chance of actually kicking the habit. This may seem counter-intuitive, but one of the advantages of these projects is that the user is constantly in contact with health professionals who can provide addiction treatment.

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