Why Harm Reduction Therapy Is Just Good Therapy: Notes from Perri Franskoviak, PhD
By: Perri Franskoviak, PhD
CAHRT member Perri Franskoviak, PhD recently wrote a piece for the Harm Reduction Therapy Center’s August 2026 newsletter that we think every client and clinician should read. Read Perri’s full article, “Harm Reduction Therapy Isn’t What You Think It Is,” on the Harm Reduction Therapy Center’s site.
Here are a few of the ideas that stayed with us.
Where her real education began
Perri writes that graduate school taught her theories, assessments, and statistics, but her real education started once she began working as a clinician more than 25 years ago. Early in her career, she worked as a psych assistant for Patt Denning, who developed harm reduction therapy with Jeannie Little. Perri calls that time “a master class” in how people actually approach change.
We are always of two minds about change
One of Perri’s central points is that ambivalence is normal. Whether the decision is about a job, a relationship, or slowing down on cannabis, part of us wants change, part of us doubts we can do it, and part of us resists it entirely. As she puts it: “we are ambivalent about change. And nowhere is this truer than if we think we’re not.”
That’s why harm reduction therapy doesn’t ask you to resolve that tension before you walk in the door. If this sounds familiar, our post on making peace with ambivalence goes deeper.
The relationship is what matters most
Perri points to decades of psychotherapy research showing that the quality of the relationship between client and therapist matters more than any particular model. In practice, that means listening closely, reflecting what clients are experiencing, and respecting the choices people make to protect themselves, including the choice to use drugs.
She is also clear about what harm reduction therapy is not. It isn’t putting up with behavior a therapist doesn’t understand. And it isn’t programs that require people to act as if they’ve already been treated before they’re allowed to start treatment.
Just good therapy, nothing added
For Perri, being a harm reduction therapist comes down to curiosity, the courage not to know, respect for each person’s autonomy, and awareness of our impact on one another. “Harm reduction therapy is just good therapy,” she writes. Nothing added.
That idea is at the heart of what harm reduction therapy is and how CAHRT members practice it.
Find a therapist who meets you where you are
If you’re looking for support that starts with you, not with a predetermined goal, browse the CAHRT provider directory or learn how to find a harm reduction therapist in California.
Originally published in the Harm Reduction Therapy Center’s August 2026 newsletter.
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