Andrew Tatarsky Ph.D.

Beyond Disease

The Positive Change Pathway

Step One: Setting the stage for change.

Posted Nov 14, 2019

If you are concerned about your substance use or other potentially risky or problematic behaviors, you can work through the Positive Change Pathway, a six-step guide I developed to help people create their optimal relationship to these behaviors—whether that means reduced, safer, more controlled or not at all. The guide applies the principles of Integrative Harm Reduction Psychotherapy (IHRP) to a self-guided change process. This is the first of six steps that I will share on this blog.

 Andrew Tatarsky
Source: Andrew Tatarsky

Create an Attitude Conducive to Change

To put yourself in the best position to make positive changes in your life, try to view the place where you are now and the behaviors you are considering changing with self-acceptance, self-compassion, kindness, and curiosity. This will help clear the path to learning and change and create a solid, safe foundation for the rest of your work.

Embrace not knowing. Beginning the positive change process does not require that we know what the outcome of our journey will be—we just begin. 

Assess the benefits and costs. Spend some time reflecting on what you think and feel about your use of substances and other potentially risky behaviors, your reasons for engaging in them, and why you might be experiencing difficulties with them. What is true for you?

Examine what you think and feel about yourself for having these difficulties. Are you feeling any difficult emotions such as shame, guilt, and anxiety? Can you identify any stigmatizing ideas about yourself as a person who uses drugs or engages in other problematic behaviors, or tendencies to be overly self-critical, self-hating, or self-attacking?

Have you unwittingly assumed that you are powerless to do anything about your substance issues, short of stopping altogether? These feelings and ideas can interfere with learning and discovery and can be cleared out of the way by curiosity, self-acceptance, and self-compassion.

The tendency to take on others’ points of view can interfere with the discovery of our own truth. Try to identify and separate your own desires and perspectives from others’ judgments and wishes for you—take these into consideration as important but don’t simply accept them.

Get in the driver’s seat of your change process!

You might counter any assumption that you are powerless by thinking of getting in the driver’s seat of your own process of change. Pursuing any learning or change requires you to take charge of the process. As with driving, skiing, and swimming (all potentially lethal activities), you will need good skills (capacities for change); you may need a teacher or coach (a trusted friend or an appropriate professional); you will need to know where you want to go (goals); and you will need to know a route that will get you there (techniques and strategies).

Spend some time thinking, journaling, or talking about how you feel about getting in the driver’s seat of your change process. Consider whether you have any fears about taking charge or self-defeating beliefs about your ability to do so. Write them down and reflect on how realistic they are.

You might do this work in self-reflection, journal about it, or find a trusted person to talk with about it.

In future posts, I will share the next five steps that address other aspects of the positive change process. Let me know how your positive change process unfolds! Enjoy the process.


Tatarsky, A. & Kellogg, S.H. (2010) Integrative Harm Reduction Psychotherapy: A Case of Substance Use, Multiple Trauma, and Suicidality. Journal of Clinical Psychology: In Session, Vol. 66 (10), pp.123-135. 

Tatarsky, A. (2002). Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. Northvale, NJ: Jason Aronson, Inc.