Author: Jacob Rosedale, PhD, LPC (affiliation National University, Bellevue University) Abstract Autonomy support has emerged as a critical yet under-specified component of effective addiction treatment. Although motivational and alliance-based frameworks emphasize the importance of client agency, the field has offered limited guidance regarding how autonomy is communicated in real-time clinical interactions, particularly during early treatment sessions. This article examine

The therapeutic alliance is one of the most reliable predictors of engagement and treatment outcome across psychotherapies, yet its role becomes especially consequential in substance use disorder (SUD) treatment, where ambivalence, shame, and fluctuating motivation are common. This integrative review synthesizes contemporary alliance research, process-outcome findings, and motivational science to clarify how relational mechanisms function as active ingredients in addiction tr

Author: Rosedale, Jacob PhD, LPC Jacob Rosedale Therapy, Independent Clinical Practice, Ramat Beit Shemesh, Israel National University, Department of Psychology, San Diego, California, USA Abstract Substance use disorder (SUD) treatment continues to face challenges related to engagement, early dropout, and inconsistent long-term outcomes. Although the therapeutic alliance is one of the most reliable predictors of success across treatment modalities, far less is known about th

The therapeutic alliance is widely recognized as a central mechanism of change in psychotherapy, yet in addiction treatment it is frequently subordinated to technique, compliance, and procedural efficiency. Despite extensive empirical support linking alliance quality to engagement, retention, and outcomes, clinical training and institutional practices often constrain the relational conditions necessary for effective treatment.

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If you’re struggling with addiction, marital discord, or the deep wounds they leave behind, you don’t have to face it alone. In my work, I combine evidence-based approaches like Dialectical Behavior Therapy (DBT) to build emotional regulation, Motivational Interviewing (MI) to strengthen commitment to change, and EMDR to process the traumas that often fuel addictive patterns and relationship pain. Together, we’ll work to break destructive cycles, heal emotional injuries, and

If you’re struggling with addiction, marital discord, or the deep wounds they leave behind, you don’t have to face it alone. In my work, I combine evidence-based approaches like Dialectical Behavior Therapy (DBT) to build emotional regulation, Motivational Interviewing (MI) to strengthen commitment to change, and EMDR to process the traumas that often fuel addictive patterns and relationship pain. Together, we’ll work to break destructive cycles, heal emotional injuries, and

If you’re struggling with addiction, marital discord, or the deep wounds they leave behind, you don’t have to face it alone. In my work, I combine evidence-based approaches like Dialectical Behavior Therapy (DBT) to build emotional regulation, Motivational Interviewing (MI) to strengthen commitment to change, and EMDR to process the traumas that often fuel addictive patterns and relationship pain. Together, we’ll work to break destructive cycles, heal emotional injuries, and

If you’re struggling with addiction, marital discord, or the deep wounds they leave behind, you don’t have to face it alone. In my work, I combine evidence-based approaches like Dialectical Behavior Therapy (DBT) to build emotional regulation, Motivational Interviewing (MI) to strengthen commitment to change, and EMDR to process the traumas that often fuel addictive patterns and relationship pain. Together, we’ll work to break destructive cycles, heal emotional injuries, and

If you’re struggling with addiction, marital discord, or the deep wounds they leave behind, you don’t have to face it alone. In my work,...

If you’re struggling with addiction, marital discord, or the deep wounds they leave behind, you don’t have to face it alone. In my work,...

If you’re struggling with addiction, marital discord, or the deep wounds they leave behind, you don’t have to face it alone. In my work,...

Infidelity is a relational trauma. Healing from it isn’t like flipping a switch or “just forgiving and forgetting.” It requires rebuilding something that was shattered: safety, trust, emotional connection, and even your sense of self. Some couples do choose to part ways, and that decision is valid. But many couples choose to fight for their relationship—and not just to survive, but to grow stronger than before.

If you've been betrayed, you're probably riding an emotional rollercoaster that no one warned you about. One moment you’re numb. The next you're sobbing. Then you're enraged. Then confused. Then right back to numb again. Let me tell you something straight: You're not crazy. You're traumatized.

When people hear the word “infidelity,” most immediately think of physical cheating. But infidelity wears a lot of faces—and many of them don’t involve sex at all. Sometimes it’s the text messages that never get shared. Sometimes it’s the long, secretive chats with a co-worker. Sometimes it’s the hidden social media accounts. And sometimes, it’s porn use that spirals into secrecy and emotional withdrawal.

One of the most confusing things I hear from clients is this: "I love my partner. I want connection. But the closer we get, the more I pull away. Why do I do this?” If that sounds familiar, you’re not alone—and you’re not broken. Addiction and intimacy often don’t play well together. In fact, many people caught in addiction—especially sex or porn addiction—have a love-hate relationship with closeness. They crave it deeply, but when it shows up, it feels threatening. Scar

Trauma, Attachment, and Addiction: Why the Past Won’t Stay in the Past. So many people I work with come in thinking their addiction is the problem—but more often than not, it’s actually the symptom. If you’ve ever wondered, “Why do I keep doing this when I know it’s hurting me?” or “Why do I feel so empty or anxious all the time?”—you’re asking exactly the right questions. And to answer them, we have to go backward before we can move forward.

Reward and Motivational Systems in the Brain: How Addiction Hijacks Our Natural Circuitry. The reward system, also known as the mesolimbic dopamine system, is a group of interconnected brain regions that process and reinforce rewarding stimuli.

My approach to addiction treatment is based on my own personal journey of recovery. I have been in the shoes of my clients, and I understand the struggles they face. This experience has given me a unique perspective and has inspired me to become a highly effective addiction counselor and lecturer.

Diagnosing addiction, or substance use disorder (SUD), is a complex process that requires careful assessment by trained professionals. Diagnosis is crucial for determining appropriate treatment and support strategies. This blog post will explore the current diagnostic criteria and challenges in diagnosing addiction.