All the research on the effectiveness of different kinds of therapy shows that what matters is not the form of the therapy but the nature of the relationship between the therapist and the client. Clients are rarely interested in the theory of therapy that the therapist espouses. What they want is a relationship with a person who is genuinely interested in them, and who is able to become a reliable point in the client's empty and chaotic internal landscape. In group therapy the group itself becomes the reliable point.

People who don't understand what therapy is about and who want to believe that they're superior to those in need of help often use pseudo-medical terms like "addictive personality". Nobody has a personality, addictive or otherwise. "Personality" is an abstract noun which refers to an individual's more or less regular ways of thinking and acting. These ways of thinking and acting change with time and circumstances.

Every action has a purpose. The actions we call addictions have two possible purposes. The first is to give us a break from the reality of our life. Some people relax in the afternoon with coffee and chocolate cake, and some people have a gin and tonic at the end of their working day. These kinds of addictions are rarely called addictions because everyone has this kind of addiction. As TS Eliot said, "Humankind cannot bear very much reality".

The second purpose of addictions is to act as a defence against memories and feelings that threaten to overwhelm the person's sense of being a person. This is illustrated in the testimonies by men who, as children, were sexually assaulted by Catholic priests. Here the men talk about their heavy drinking and about being depressed, both of which are defences against being overwhelmed by memories and feelings. In their descriptions of the assault they told how totally helpless they felt in the hands of a man who, as well as inflicting pain, warned them that God would punish them if they told what had happened to them. They were also told that what was happening to them was their own fault.

When our sense of being a person is in danger of being overwhelmed, we feel that we are about to be wiped out as a person. We shall become a no-thing. This is utterly terrifying. If we have considerable self-confidence, we can tell ourselves that we shall survive this experience, but, if we see ourselves as unacceptable, even wicked, we feel that we are always in danger of being destroyed as a person. We can try to blot out our memory of the terror by consuming alcohol, but, no matter how much we drink, it is never enough. Or we can blame ourselves for what has happened to us, and thus become depressed. We can then drink to blot out the pain of being depressed.

Alcoholism and depression are only two of a number of desperate defences that we can use to try to fend off the fear of being annihilated as a person. Whatever defence we unconsciously choose to use, the only way to eradicate the need for a desperate defence is to arrive at the position where you value and accept yourself. In a good therapeutic relationship the client has the opportunity to come to value and accept himself, and to use this to create the courage to face what he needs to face in his life. In chronic illnesses like diabetes, epilepsy and cystic fibrosis where the physical basis of the disease has been clearly demonstrated, individuals will readily learn to manage their illness if they value themselves and are determined to be as healthy as possible and lead as normal a life as possible.

The AA philosophy that teaches that alcoholics have a chronic illness which renders them incapable of looking after themselves, and so they must submit themselves to a higher power, prevents them from being able to value and accept themselves. Resolving not to drink again has saved the life of many people, but this is like the situation where a sailor manages to get from his wrecked ship to rocks above the stormy sea but lacks the courage to cross the rocks to solid land.

• Dorothy Rowe's Beyond Fear (3rd edition) is published by HarperCollins