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Rarely has counselling been so deeply analysed as in this US study of mainly alcohol and cocaine dependent patients. The far-reaching implications are that some counsellors generate relationships with clients which feed through to better outcomes – but also that the 'best' relationship builders are not on average the most effective.
Chicago studies have shown that quarterly check-ups on former patients can identify need and pave the way for treatment re-entry. Though extra substance use/problem reductions were modest, these remained significant four years after the patients started treatment. Issue for the UK: how does this square with the stress on lasting treatment exit?
Does implementing evidence-based psychosocial therapies actually lead to the intended practice changes and do these make things better for the clients? From this review, most clearly when the whole organisation is enrolled in the effort and training is bolstered by systematic and expert continuing supervision.
One of our selection of Hot Topics – important issues which sometimes generate heated debate over the facts or their interpretation. Click to read introductory text and trigger a customised search for relevant documents.
Probably more than any other, this seminal study heightened the profile of the therapist's interpersonal style in substance use counselling, seeming to confirm that by not provoking resistance, the non-confrontational style mandated by motivational interviewing reduced drinking compared to the then more typical blunt and challenging approach.
At Californian methadone clinics, group education sessions led by a nurse and focused on the risks of aggravating hepatitis infection led to the same substantial reductions in drinking as one-to-one or group motivational interviewing conducted by highly trained counsellors, offering a cost-effective means to reduce alcohol-related risks.
Analysis of counselling session recordings from therapists trained in motivational interviewing suggests that the important quality of seeming 'genuine' can suffer if training mandates unnaturally withholding normal responses; however, departing from these tenets is risky unless done by a socially skilled therapist.
US study suggests that when it comes to choosing therapists, choosing the 'right' people who have not been trained in motivational interviewing would be better than choosing the 'wrong' people who have been trained; the former not only start at a higher level, but are more able to benefit from and retain training.
The primary care arm of the largest alcohol screening and brief intervention study yet conducted in Britain found that the proportion of risky drinkers fell just as much after the most minimal of screening and intervention methods as after more sophisticated and longer (but still brief) alternatives.
Across the most rigorous studies, this synthesis of the research finds therapies based on motivational interviewing better than doing nothing, but no more effective than usual/other treatments for problem drinkers and drugtakers – powerful further support for the 'Dodo bird' verdict that all bona fide therapies are equivalent.
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