Drug Treatment Matrix cell B4: Practitioners; Psychosocial therapies

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Practitioners; Psychosocial therapies

Seminal and key studies on the impact of the practitioner in psychosocial therapies. Takes Carl Rogers’s seminal theories as its starting point and guides you through the complexities which obscure the impact of client-worker relationships despite their patent important to the clients.


S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Fundamentals of effective therapy: genuineness, positive regard and empathy (1957; free source at time of writing). In psychosocial counselling and therapy, no paper has had more influence than Carl Rogers’ formulation of the “necessary and sufficient conditions” for clients to get better, the foundation of arguably all effective substance use counselling. See also commentaries (1 2) on his work. For discussion click and scroll down to highlighted heading.

S Connection with counsellor promotes client progress (1997). Findings at a US treatment service for “for indigent drug users” led researchers to argue that “providing the opportunity to develop appropriate relationships may be one of most important contributions made by treatment”. Psychologically healthy patients forged better initial relationships with their counsellors, but across all patients better relationships were followed by greater improvements in psychological health. For related discussion click and scroll down to highlighted heading.

K Treat manuals as guides, not scripts (2006). Especially when the therapeutic relationship is not going well, counsellors should be prepared to depart from the counselling ’script’ without altogether abandoning it. That implication came from a national US study (1999) of cocaine dependence treatment, which also found typical drug counselling at least as effective as psychological therapies. For discussion click and scroll down to highlighted heading.

K Can therapists be too accommodating? (2009). Rarely has counselling been so deeply analysed as in this US study involving mainly alcohol- and cocaine-dependent patients. Expected finding was that some counsellors generate relationships with clients which feed through to better outcomes; less expected was that the very ‘best’ relationship builders were not on average the most effective. For discussion click and scroll down to highlighted heading.

K Authenticity and social skills in motivational interviewing (2005). US study suggests that the quality of seeming ‘genuine’ can suffer if training mandates withholding natural responses, but also that departing from these mandates is risky unless done by a socially skilled therapist. See also an essay (2013) from Drug and Alcohol Findings based on this and other studies, arguing that ‘by the book’ is not always best way to do therapy. For discussion click and scroll down to highlighted heading.

R Common core of effective therapy: therapeutic relationships (American Psychological Association, 2018). Includes but not specific to substance use. Introduces and synthesises finding from 16 reviews of the psychotherapy literature based on the understanding that therapeutic change is generated not only by technical interventions, but by the ways therapists relate to clients, like forming a therapeutic alliance (related review below), being empathic, and appropriately adjusting to the individual (related review below). Still valuable is an earlier version (2011) of this article which additionally integrated findings on how to adapt therapy to the individual client and on counterproductive behaviours like being confrontational. Drawing on this work see also a broader practice-oriented interpretation (2014) of the research from same lead author.

R Therapists who form good therapeutic relationships have better outcomes (American Psychological Association, 2018). One of the (see above) US American Psychological Association task force reviews. Supports the argument that “a good working relationship is an important determinant of treatment success, and that nurturing, maintaining, and as needed, re-establishing such a relationship, are core tasks not just in psychosocial therapies, but in treatment generally”. Earlier an advanced synthesis of research findings (2012; free source at time of writing) from some of the same authors had confirmed that some therapists consistently develop stronger relationships and have better outcomes.

R Adapt to the client (American Psychological Association, 2011). Includes but not specific to substance use. US American Psychological Association task force (their overall report is listed above) judged that adapting psychotherapy to the client’s reactance/resistance, preferences, culture, and religion/spirituality demonstrably improves effectiveness.

R Some clients like to lead, others to be led (2006). How directive the therapist is during treatment is one of the strongest and most consistent influences on outcomes. There is no ‘right’ degree of directiveness; it all depends on how the client reacts.

R Strong therapeutic relationships mean patients stay longer (2005). Among samples mainly being treated for problems with illegal drugs, the therapeutic relationship between patient and worker early in treatment was more consistently related to engagement and retention than to substance use, especially when use was assessed at times distant from the assessment of the alliance. See this study (2002) for an example of the review’s findings. For discussion click and scroll down to highlighted heading.

G Implementing NICE-recommended psychosocial interventions ([English] National Treatment Agency for Substance Misuse, 2010). Report from the British Psychological Society on how to implement recommendations in guidance from the UK’s National Institute for Health and Care Excellence on treating drug misuse; includes competencies and attributes of therapists.

G Addiction counselling competencies ([US] Substance Abuse and Mental Health Services Administration, 2008). Includes competencies associated with positive outcomes and the knowledge, skills, and attitudes all substance use counsellors should have. First step is to “Establish a helping relationship with the client characterized by warmth, respect, genuineness, concreteness, and empathy.”

G What makes a good group therapist? ([US] Substance Abuse and Mental Health Services Administration, 2005). US consensus guidance on the different types of groups, how to organise and lead them, desirable staff attributes, and staff training and supervision.

G What makes a good case manager? ([US] Substance Abuse and Mental Health Services Administration, 1998). US consensus guidance including the staff skills, knowledge and attitudes needed to fulfil the key case management role orchestrating the range of services often needed to promote lasting full recovery.

more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page. Also see hot topic on treatment staff.

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