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Keywords:

  • harm reduction therapy;
  • engagement;
  • dual diagnosis;
  • homeless;
  • psychotherapy;
  • mental health;
  • substance abuse

Abstract

Harm reduction therapy was originally developed as a nonabstinence-based method of treating people with drug and alcohol problems. In this article, we describe and apply the principles and practices of harm reduction therapy in community settings, places where people congregate for nontherapeutic reasons—street corners, community drop-in centers, needle exchanges, and primary care clinics. Low-threshold welcome and flexible session arrangements are defining characteristics of this community-based approach. We have been instrumental in developing several programs, three of which are described here. These programs work with more than 1,000 clients per year, with varying levels of intensity. The programs offer drop-in or sidewalk sessions, drop-in support groups, regular therapy appointments, and psychiatric medications. Many impressive outcomes, such as reduction of harmful drug use, stabilization of psychiatric problems, and permanent housing, are found each year. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66: 1–14, 2010.