“Sock-Puppet” Effect In Treatment


There is a level of resistance in addiction which I’ve found one of the most challenging as it’s often one of the hardest forms of denial I’ve encountered.

It is a form of resistance that is akin to a “sock-puppet“.

So what is a sock-puppet and why does it occur?

Quite simply a sock-puppet is a facade or persona(mask) of someone who is seeking treatment and support. They willingly engage in tasks and show a level of compliance but they have not made their minds up that they want to commit to any level of real change.  They feel uneasy about talking about themselves and chose to over-generalize and dream up scenarios that don’t relate to self.

Rather than answering a question they will imagine up a scenario and answer it in the form of the sock-puppet, rather than choosing to look at themselves they instead look at the sock-puppet in the third person which defeats any real cognitive awareness.

It is very similar the compliant child in TA ego states ( http://mcpt.co.uk/transactional-analysis-and-ego-states/ )

How to spot a sock-puppet:

  • Will always avoid using I statements
  • Avoid talking about their drug of choice
  • Over-generalize
  • Change topics
  • Talks out of time, gives point of reference to dates no longer in context with questions
  • May lack experience of making a change in their life
  • Has been forced into treatment by external forces

Why does the sock puppet effect occur?

It could be due to an over-adaptive child ego state, perhaps a learned-behavior of dealing with a dysfunctional house-hold.

However, I think that the sock-puppet effect most likely occurs from a mixture of two vital components:  Shame and denial.

Shame – Addicts by the by are mostly shamed, even though there seems to be an increasing level of understanding towards addiction, people still feel a huge sense of shame.  Some people feel such a huge level of shame with themselves and their position in the world that they feel incapable of connecting with themselves. They feel absolutely defeated whenever they connect to their more vulnerable side and simply won’t allow themselves to experience it.

Denial – Denial is a broad field. It is a natural self-protective measure in order to prevent feeling pain or suffering, but unfortunately it also serves to incubate addiction.  Some people feel absolutely incapable of giving an honest account of where they are in terms of addressing their substance use issues or addiction through fear of clinical reprisal or peer rejection(in treatment or in peer support groups).

A person may feel that they have reservations, they may wish to harm-reduce or minimize their usage. This may not be in-line with their current treatment program, or their perceived ideal-self.

They may be fantasizing about returning to manageable level of drink or drugs, when they are invited to explore how realistic this is they put a compliant sock-puppet version of themselves. This is done in order to prevent an increase in cognitive-dissidence which causes them emotional pain or a fear that their crutch will be kicked away.

For example: A person who is a lone vodka drinker will talk about scenarios such as refusing alcohol in pubs and clubs when they may not have been to a club or pub in many years. 

They do not connect to the realities they will be facing.

Sock-puppeting through treatment prevents real changes from taking place, a person will not actively dispute their health-behavior changes at all.  They are very unlikely to make any changes in their habits.  Unfortunately people die as a result of this effect. Able to comply with treatment but they could not be themselves in treatment  -They may be planning to go back to drugs or drink but are unable to explore that side of themselves.

Addiction is a huge problem, the best possible outcome any clinical practitioner of their field could want is their client/patient to remain drug free and live a happy and fulfilling life.   However, one must be very careful that they are not projecting an ideal-self upon their clients and not allowing them to explore their ambivalence towards change.  If you believe a client has a sock-puppet on, then you must try an enhance their level of awareness. Bring them back to themselves, get them to use I statements, focus on the present and use motivational-interviewing styles of practice to explore reservations and ambivalence.  Extending length of treatment is also a good idea where they can let their addiction settle and in turn explore if they are still in a form of denial.

-Written by Dylan Kerr  (2016)


  1. Hi Dylan
    Thank you for your post.
    I like your metaphor of the sock puppet and compliment client.
    Like you say these can be learnt survival skills.
    I like to mention the poppy syndrome were clients don’t like to put there head to far over the parapet in case they get shot down. So remain silent and avoid conflict at all costs keeping there head down. A client came to see me who was a high achiever in therapy but her achievements were never recognised by her parents she was encouraged to keep her head down although others in the family could talk about there achievements. She said she felt never good enough but would talk about things she had done an then ask me if l had heard of certain new therapies ones she had done she was also a therapist . When I hadn’t heard of them the transference that she was leaving me with was that l wasn’t good enough. I haven’t had the chance to interpret this back to her because she was also a drunk in denial an has gone awol. So there we have it high achieving addicts in denial hiding behind the intellectual mask.Fear the word acceptance in case there ideal self comes tumbling down.


      1. Thanks Dylan
        Yes it’s difficult to break down denial finding your own approach is key in breaking down denial l have learnt rolling with the resistance.
        Have you anything on pc game addiction in terms of approach seems to be a growing addiction amongst young people.


      2. It’s something I am looking into at the moment Richard. It’s a huge problem.

        I have discovered it is mostly MMORPG’s or online games where you continually progress as opposed linear story-based games.

        A lot of the clients I worked with in the past had “schizoid” personality types or other cluster-A personality types. To be frank, my success with them was very limited, partly this was due to rehabs of the past allowing them to act-out on their addiction (mobile phone gaming whilst in treatment) .

        A lot of the young men I worked with displayed high levels of aggression but mostly passive aggressive traits,such as damaging property.


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