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Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

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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 accurate empathy (1957). 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 much – arguably all effective – substance use counselling. See also commentaries (1 2). For discussion click and scroll down to highlighted heading.

S Connection with counsellor promotes client progress (1997). Findings at a US drug treatment service 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 this essay (2013) based on the same 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 Effective ways to relate to clients (2011). US American Psychological Association task force reviews evidence and offers guidance on outcome-enhancing qualities in relating to psychotherapy clients, like forming a therapeutic alliance (see below), being empathic, and appropriately adjusting to the individual (see below). Also offers guidance on outcome-harming qualities like being confrontational. Includes but not specific to substance use. See also this later (2014) and broader practice-oriented interpretation from same lead author, drawing on the task force’s work.

R Therapists who form good therapeutic relationships have better outcomes (2011). One of the (see above) US American Psychological Association task force reviews. In substance use treatment and psychosocial therapy generally, a good working relationship between therapist and client is “one of the strongest and most robust predictors of treatment success”. An advanced analysis (2012; free source at time of writing) confirmed that some therapists consistently develop stronger relationships and have better outcomes.

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

R Some clients like to lead, others to be led (2006). How directive the therapist is during the 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). 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; 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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