Integrative Therapy for Addiction and Compulsion
A Harm Reduction Approach
Andrew Tatarsky, Ph.D.
Dear Colleague,
If you’ve ever worked with a client struggling with addiction or compulsive behavior, you’ve likely felt the weight of how complex, and often misunderstood, this work can be.
You may have wondered why so many people who sincerely want help end up dropping out of treatment? Or why traditional models seem to alienate rather than engage? Or why a person’s substance use continues even when it’s causing real harm in their life?
I’ve spent the last 30 years asking those same questions.
Early in my career, I was committed to helping people recover—but I kept encountering clients who didn’t fit the mold of what I’d been taught. They weren’t “in denial.” They weren’t “resistant.” They were human beings in pain, carrying trauma, shame, unmet needs, and profound meaning in their relationship to substances or behaviors. And they needed something different.
That realization led me to develop Integrative Harm Reduction Psychotherapy (IHRP)—a radically compassionate, client-centered approach that bridges harm reduction with psychodynamic, cognitive-behavioral, and mindfulness-based methods.
This course distills the most essential concepts and clinical tools from the IHRP model, so that you can meet your clients wherever they are, in whatever stage of change, and help them move toward healing, growth, and self-determination.
Together, we’ll explore how to work with the meaning behind their substance use… how to support clients who aren’t ready or willing to stop… how to build real therapeutic alliance rooted in safety and collaboration… and how to reframe addiction through a psychobiosocial lens that’s grounded in science and social justice.
Whether you’re new to harm reduction or looking to deepen your clinical skill set, this course will give you a roadmap for doing this work with more clarity, compassion, and impact.
I hope you’ll join me.
Warmly,
Andrew Tatarsky, PhD
& Academy of Therapy Wisdom
“Harm Reduction Therapy arose as a corrective response to the failure or limitations of traditional addiction treatments. The way that I see it is that the harm reduction frame is a set of principles that really frame helping relationships. The essence of that is we want to invite people into helping relationships without imposing presumptions about the nature of the problem or the nature of addiction. The goal is an approach to change. It’s really about keeping our agendas to the side so that we can create a safe space to support people in discovering what’s true for them about this complex addictive relationship.”
~ Andrew Tatarsky
This in-depth training with Dr. Andrew Tatarsky introduces you to
Integrative Harm Reduction Psychotherapy (IHRP), a cutting-edge, trauma-informed framework that helps you meet clients wherever they are in their process. Whether they’re using substances, self-injuring, or wrestling with ambivalence about change, IHRP gives you the tools to engage them safely, ethically, and effectively.
This course is made up of 7 on-demand modules, and 7 LIVE calls with Andrew Tatarsky where you’ll dive deeper into the content and can ask questions that come up while you’re going through the course.
You’ll learn how to:
- Understand the psychological, biological, and social drivers of addiction so that you can move beyond one-size-fits-all models and tailor your approach to the unique needs and motivations of each client.
- Support clients who aren’t ready—or don’t want—to stop using so that you can build meaningful therapeutic alliances and facilitate change without requiring abstinence as a precondition.
- Navigate trauma, shame, and dissociation in addictive behavior so that you can identify what’s fueling the compulsion and address the underlying wounds with compassion and care.
- Use the “urge” as a clinical entry point for transformation so that instead of suppressing or controlling addictive impulses, you can help clients explore them as opportunities for self-understanding and growth.
- Incorporate mindfulness, motivational interviewing, and somatic tools so that you can help clients regulate their nervous systems, reduce harm, and build sustainable coping strategies.
- Work through your own countertransference with clarity and confidence so that you can stay grounded and reflective even in the face of high-risk behaviors or powerful emotional responses.
Through theory, case vignettes, practical techniques, and embodied exercises, this course gives you a comprehensive, evidence-based foundation for working with addiction and compulsion, whether you’re a seasoned clinician or just beginning to explore harm reduction therapy.
Here’s what you can expect
from each module in this course…
Module 1
February 26th from 12-1:30pm EST
Overview of the Training
In this foundational module, you’ll explore why the dominant narratives around addiction, like the disease model and abstinence-only treatment, fall short for so many clients. You’ll be introduced to a harm reduction framework that centers compassion, meaning, and collaboration, setting the stage for a more effective therapeutic approach.
In this module, you’ll learn:
- Why current treatment models fail the majority of people who struggle with addiction so that you can stop blaming yourself or your clients for a system that doesn’t work.
- The cultural myths and stigmas that shape how we see substance users so that you can bring more curiosity and humanity into your clinical work.
- What a harm reduction approach actually is, and how it applies to psychotherapy so that you can support clients in making “any positive change,” not just abstinence.
- How trauma, habit, and meaning intertwine in addictive behaviors so that you can see substance use not just as a problem, but as communication.
- Why a psychobiosocial model of addiction is more accurate and inclusive so that your interventions reflect the full complexity of your clients’ lives.
Module 2
Harm Reduction From Public Health to Psychotherapy
March 12th from 12-1:30pm EST
This module provides a deep dive into the core principles of harm reduction and how they translate into therapy. You’ll learn how harm reduction evolved from public health into a full-spectrum clinical framework that welcomes clients without judgment, and supports them in making meaningful, client-defined changes.
In this module, you’ll learn:
- The history and evolution of harm reduction, from syringe access to psychotherapy so that you can align your clinical practice with a broader movement rooted in dignity and justice.
- The four pillars of harm reduction in the U.S. grassroots advocacy, public health, housing first, and treatment so that you can see your work as part of a larger, systemic response.
- How to apply harm reduction principles in your therapy room so that you can build safety, lower the threshold for engagement, and meet clients where they are.
- Why it’s essential to tailor services to individual goals so that your clients feel empowered and invested in their own healing.
- How to reduce risk while building motivation and trust so that clients stay in therapy long enough to experience meaningful change.
Module 3
March 26th from 12-1:30pm EDT
Why Harm Reduction is Essential to Effective Helping: Rationale and Theory
In this module, you’ll explore the psychobiosocial roots of substance use and addictive behavior, including trauma, disconnection, shame, and social marginalization. You’ll also learn how to engage clients who are ambivalent about change and not ready to stop.
In this module, you’ll learn:
- The multiple meanings behind substance use so that you can better understand your clients' internal conflicts, needs, and coping strategies.
- How risky behavior expresses dissociated or split-off parts of the self so that you can work with urges as a doorway to deeper integration and healing.
- The limitations of the disease model—and why many clients recover without formal treatment so that you can stop pathologizing normal human responses to pain.
- How trauma impacts the nervous system and fuels addiction so that you can address the root cause instead of just the symptom.
- How to support clients in pre-contemplation or ambivalence so that you can build rapport and facilitate progress even when abstinence isn’t a goal.
Module 4
April 9th from 12-1:30pm EDT
Creating a Safe Relational Container
This module focuses on the relational heart of harm reduction therapy: creating a safe, nonjudgmental container that allows clients to explore their behaviors without fear of shame or rejection. You’ll learn how to manage alliance ruptures, offer corrective experiences, and use the relationship itself as a healing agent.
In this module, you’ll learn:
- Why the therapeutic alliance is the single strongest predictor of outcomes so that you prioritize connection over control.
- How to create a “low-threshold” experience for therapy engagement so that clients feel safe enough to open up.
- Ways to respond skillfully to client behavior that might trigger countertransference so that you remain grounded and attuned even in difficult moments.
- How to co-create goals and treatment plans with clients so that they feel ownership of the process.
- The role of transparency, collaboration, and empathy in repairing ruptures so that your clients experience a new, healing kind of relationship.
Module 5
April 23rd from 12-1:30pm EDT
Self-Regulation and Assessment
Addictive urges are often treated as something to be suppressed or controlled, but in this module, you’ll learn how to use them as powerful entry points for transformation. You’ll explore how to bring mindful attention to urges, decode their meaning, and support clients in building new behavioral pathways.
In this module, you’ll learn:
- Why urges are not the enemy, but a map to unmet needs so that you can work with, not against, the body’s messages.
- How to use “urge surfing” to increase distress tolerance and self-regulation so that clients can stay present without acting on harmful impulses.
- Techniques for “unwrapping the urge” and exploring the story behind it so that clients build insight and agency.
- How to connect urges to relational, emotional, or traumatic material so that clients begin to understand their behavior in context.
- Why this mindful approach helps integrate dissociated parts of the self so that healing becomes more than just symptom management.
Module 6
May 7th from 12-1:30pm EDT
Action Planning for Positive Change
In this module, you’ll move from insight to action. You’ll learn how to help clients develop personalized, harm-reduction-based goals that reflect their lived reality, not someone else’s idea of success. You’ll also explore techniques for supporting change without coercion, working skillfully with ambivalence, and creating “optimal use plans” that reduce harm while building momentum toward healing.
In this module, you’ll learn:
- How to embrace and work with client ambivalence so that you stop seeing “resistance” as a problem and start using it as a therapeutic opportunity.
- How to guide clients through motivational dialogues and decisional balance exercises so that they gain clarity and agency over their choices.
- How to collaboratively develop harm reduction goals so that progress becomes accessible, realistic, and sustainable for each client.
- What an optimal use plan looks like and how to use it to reduce risk and increase self-efficacy so that clients feel empowered to make thoughtful, intentional changes.
- Strategies for testing, refining, and supporting behavioral experiments so that therapy becomes a space for growth, not judgment.
Module 7
May 21st from 12-1:30pm EDT
The Inner Work: Countertransference and Therapist Self-Awareness
The final module turns inward to focus on you, the therapist. Working with addiction, compulsion, and high-risk behaviors often stirs strong emotional reactions, sometimes consciously, sometimes not. In this module, you’ll explore how to recognize, manage, and learn from your countertransference, so you can remain present, compassionate, and ethically grounded in your work.
In this module, you’ll learn:
- Why countertransference is not a problem to avoid but a source of valuable clinical information so that you can deepen your insight rather than suppress your reactions.
- The common feelings, impulses, and thoughts evoked by high-risk clients so that you can recognize when your buttons are being pushed.
- Tools for managing intense affect, fear, or reactivity in-session so that you stay anchored and avoid retraumatizing clients.
- How to use mindfulness, co-regulation, and self-reflection to metabolize activation so that you bring more clarity and spaciousness into your work.
- Why peer support, consultation, and supervision are essential for sustainability so that you don’t burn out or carry this work alone.
Plus you’ll get these incredible bonuses…
Harm Reduction Psychotherapy (Book Excerpt):
A Case Example
This excerpt (Chapter 1) from Tatarsky’s book introduces the core critiques of abstinence-only models and makes a clear, persuasive argument for integrative harm reduction psychotherapy as a more humane and effective alternative. By outlining historical outcomes, treatment limitations, and the philosophical roots of the harm reduction movement, it equips clinicians with the theoretical backbone needed to fully embody the course’s teachings in their own practice.
Pioneers of Recovery Treatment – Podcast Interview
In this powerful interview Andrew shares some of his personal journey including his “drug treatment trauma” experience when he was 15 years old, and how that led him to developing his unique approach to addiction.
An Integrative Approach to Harm Reduction Psychotherapy:
A Case of Problem Drinking Secondary to Depression
This compelling case study gives learners a rare, behind-the-scenes look at how integrative harm reduction psychotherapy unfolds with a complex, dual-diagnosis client. It demonstrates exactly how a therapist can cultivate alliance, engage ambivalent clients, understand the psychological meaning of substance use, and support incremental but meaningful change. As a bonus, it grounds the course teachings in real clinical nuance and shows how theory becomes therapeutic action in the room.
Harm Reduction Psychotherapy:
Extending the Reach of Traditional Substance Use Treatment
This paper discusses the philosophical foundation of harm reduction and articulates the paradigm shift that makes Andrew Tatarsky’s work so influential. It shows why traditional abstinence-only approaches fail so many clients, and how a collaborative, flexible, client-centered model dramatically increases engagement and clinical success. This article will strengthen your ability to articulate and defend harm reduction principles to colleagues, clients, and systems.
State of the Art in Harm Reduction Psychotherapy:
An Emerging Treatment for Substance Misuse
This overview captures the evolution of harm reduction psychotherapy as a maturing, evidence-supported clinical movement. Co-authored with G. Alan Marlatt, it offers a sweeping yet accessible synthesis of the field’s history, research foundations, and core principles. Clinicians gain clarity on where harm reduction fits within modern psychotherapy and learn how the approach responds to the realities of today’s diverse substance-using clients, making it invaluable context for applying the course material with confidence.
Integrative Harm Reduction Psychotherapy:
A Case of Substance Use, Multiple Trauma, and Suicidality
This powerful clinical case demonstrates how integrative harm reduction psychotherapy functions in high-acuity situations involving trauma, suicidality, and severe substance use. It breaks down the seven therapeutic tasks of IHRP and brings them to life through detailed therapeutic process. This bonus gives you a valuable insights in navigating complexity, repairing alliance ruptures, and supporting meaningful change even when risk and ambivalence are high.
The Challenge of Harm Reduction:
Changing Attitudes Toward Addiction Treatment
This engaging article offers a vivid, humanizing exploration of real clients whose lives sit at the intersection of danger, longing, trauma, and substance use. Through story-rich case narratives and historical context, Dr. Tatarsky exposes the limits of abstinence-only thinking and invites a more compassionate, pragmatic, and clinically effective worldview. It’s an inspiring bonus that deepens the learner’s empathy and strengthens their commitment to non-stigmatizing care.
Interview with Andrew Tatarsky and Maia Szalavitz
Interview with Andrew Tatarsky and Sam Rivera
Interview with Andrew Tatarsky and Patt Denning
If you are a BIPOC helping professional,
please accept our discounted enrollment price for this course by clicking here.
We are glad to have you with us!
This program has been approved for 12 distance learning CEs by the following organizations: CAMFT, NBCC, NASW MA Chapter, NYSED MHC, and NYSED SW.
Full CE info can be found by clicking here.
100% Risk-Free Guarantee
We are confident you will learn new skills in this online training. However, if 14 days after purchase you don’t believe you will learn anything to apply with your clients, please contact our support team at support@therapywisdom.com and we will give you a full refund, no questions asked.
Andrew Tatarsky, Ph.D.
Andrew has worked with people who struggle with drugs and their families for over 40 years. He developed Integrative Harm Reduction Psychotherapy (IHRP), a model that integrates relational psychoanalysis, CBT, and mindfulness within a harm reduction framework. IHRP supports clients in discovering their truth and choosing goals and strategies that best fit their unique journeys toward positive change. His work is described in Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems—translated into Polish, Spanish, and Russian—and in numerous published papers. He holds a doctorate in clinical psychology from the City University of New York and completed postdoctoral training at NYU’s Program in Psychoanalysis and Psychotherapy. Andrew maintains a private practice in NYC, offering therapy, training, and consultation.
He is a Senior Advisor at Silver Hill New York, where he provides supervision and training in harm reduction-informed care, and he formerly founded and led the Center for Optimal Living. He also serves on the Medical and Clinical Advisory Panels for the New York State Office of Addiction Services and Support. Andrew has trained professionals and organizations in 20 countries, with a focus on advancing a re-humanized, compassionate approach to problematic substance use and expanding access to care across the harm reduction spectrum.
Our courses are at the intersection of psychotherapy, spirituality and social change.
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Frequently Asked
questions
Q: Who is this course for?
This course is designed for mental health professionals—including psychotherapists, social workers, psychologists, substance use counselors, and clinical trainees—who want to deepen their ability to support clients with substance use issues, self-harm, and other compulsive behaviors. Whether you’re new to harm reduction or looking to expand your skills, this course offers both foundational knowledge and practical tools.
Q: Do I need to specialize in addiction treatment to benefit from this course?
No. In fact, one of the core messages of this course is that if you work with trauma, you’re already working with addiction. Many clients use substances or behaviors to manage overwhelming emotions, even if they don’t identify as having an “addiction.” This training will help you recognize and respond to these patterns more effectively.
Q: Does this course support abstinence-based treatment?
Yes—and more. Integrative Harm Reduction Psychotherapy (IHRP) supports any positive change, including safer use, reduced use, moderation, or abstinence. The goal is to meet clients where they are, honor their autonomy, and support sustainable, client-defined goals—rather than enforcing a one-size-fits-all model.
Q: Will I learn concrete techniques, or is this mostly theoretical?
You’ll get both. The course blends theoretical frameworks (like the psychobiosocial model, harm reduction philosophy, and trauma theory) with practical tools—including urge surfing, motivational interviewing, countertransference strategies, optimal use planning, and somatic regulation techniques. You’ll walk away with approaches you can use immediately in your sessions.
Q: What if my client doesn’t want to stop using substances?
That’s exactly what this course is built for. Many clients are ambivalent about change or not ready to stop. This training shows you how to build meaningful therapeutic relationships with those clients, support them in reducing harm, and help them explore the underlying meaning behind their behavior without shame or coercion.
Q: How long is the course, and will I have lifetime access?
The course includes approximately 8 hours of on-demand training content, divided into seven modules. When you enroll, you’ll receive lifetime access, so you can revisit the material at your own pace and refer back to it as needed in your clinical work.
You’ll also get access to seven 1.5 hour live calls with Andrew Tatarsky.
Q: Is this course pre-recorded, or is it live where I can ask questions?
This course is a combination of 7 on-demand modules you can access anytime, anywhere, and 7 live calls with Andrew Tatarsky. Each module is filled with Andrew’s pre-recorded content, and you’ll have unlimited access to the modules.
The live calls are on the following dates:
February 26th from 12-1:30pm EDT
March 12th from 12-1:30pm EDT
March 26th from 12-1:30pm EDT
April 9th from 12-1:30pm EDT
April 23rd from 12-1:30pm EDT
May 7th from 12-1:30pm EDT
May 21st from 12-1:30pm EDT
Q: Can I get CEs for this course?
Yes! Limited Distance Learning CEs are available. Click here for more information.
Q: Do you offer scholarships or discounts?
Academy of Therapy Wisdom does not offer full scholarships for its courses but we do invite BIPOC healing professionals to enroll at our discounted rate as one way to address the economic impacts of systemic oppression and generational wealth gaps on Black, Indigenous, and People of Color.
Our discounted enrollment rate is also available to those with a financial hardship, disability or health condition, or who live in countries with a very high exchange rate for the US Dollar. If one of these applies to you, please email support@therapywisdom.com for more information.
Academy of Therapy Wisdom creates world-class learning experiences for the global therapy community, integrating spirituality and social justice to help cultivate a more just, enlightened, and compassionate world. Our courses are immensely valuable, but we don’t want the cost to be a barrier to your learning and personal growth.
