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Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

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Effectiveness Bank Drug Treatment Matrix

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Management/supervision; Psychosocial therapies

Seminal and key studies on management and supervision in psychosocial therapies. Findings challenge managers to invest in the post-training ‘coaching’ needed to make a difference for patients, and to set up systems alerting therapists to how well their clients are doing – especially when they are doing badly.


S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

K Coaching helps counsellors learn to motivate (2004; free source at time of writing). Client responses to trainees improved only when motivational interviewing workshops had been reinforced by continued expert coaching and feedback on performance. See also report from the same study suggesting that the important quality of seeming genuine can suffer if training mandates unnaturally withholding normal responses. Related cognitive-behavioural study and reviews (1 2 3 4) below. For discussion click and scroll down to highlighted heading.

K Leaders set the context for training to be implemented (2012). Whether substance use counsellors adopt and spread training-based practice improvements is strongly influenced by the ethos and support stemming from an organisation’s leadership, especially the degree to which it fosters professional development. Similar findings in review below. For discussion click and scroll down to highlighted heading.

K Put your best people up front (2000). Interactive exercises and games and induction by senior staff helped new residential rehabilitation residents engage with the programme. Study is numbered 3 in the downloaded document.

K Assess and tell counsellors how their clients are doing (2012). To maximally improve outcomes feedback needs to identify which individuals are doing poorly and recommend remedial actions. The same system has been found beneficial (1 2 3; free source at time of writing) in psychotherapy generally. Related guidance below. For discussion click and scroll down to highlighted heading.

Walk in our shoes

K Walk in their shoes (2008). When senior staff role-played the process of becoming a new client it helped halve waiting times and extend retention at substance use counselling and residential services. See also report on an extension (2012) to the programme and an account (2007; free source at time of writing) of the ‘walk-through’ procedure. Discussion in cell C2. For related discussion click and scroll down to highlighted heading.

K Don’t make counsellors stick to the manual no matter what (2006). Findings from a US study of cocaine dependence treatment suggest that – especially when the therapeutic relationship is not going well – counsellors should feel free to depart from the counselling ’script’ without altogether abandoning it. Data came from a national study (1999) which found drug counselling at least as effective as psychological therapies. Related review below.

K Screening applicant therapists for empathy saves on training (2005; free source at time of writing). About alcohol treatment but applicable to other substance use problems. Research project saved on training by using responses to simulated clients to screen applicant therapists for ‘accurate empathy’. Same method could help services spot people with the hard-to-teach (2006) ability to form good relationships with clients. See Alcohol Treatment Matrix for related discussions of empathy and of staff recruitment.

K Reading the manual not enough to develop competence in cognitive-behavioural therapy (2005; free source at time of writing). After being told to‘read the manual’ just 15% of substance use counsellors and clinicians were acceptably competent. Web-based training comparing role-plays to the ideal helped, but greater and more consistent gains were made after a training seminar was reinforced by expert coaching based on taped sessions with real clients. Counsellors who were former substance users (presumed likely to be 12-step adherents and least familiar with formal therapies) benefited most from being coached rather than being told to read the manual. Related motivational interviewing study above and reviews (1 2 3 4) below. For discussion click and scroll down to highlighted heading.

R Implementation lessons from trials of psychosocial therapies (2007; free source at time of writing). Research shows importance of therapist selection and post-training supervision, and the pitfalls of assuming researched interventions will translate into routine practice and of relying on the therapist’s self-assessment of their competence. This single review covers many of the issues management faces in trying to implement evidence-based practice. For discussion click and scroll down to highlighted heading.

R Let motivational counsellors adapt to the client (2005). Effectiveness Bank review and a synthesis of the research (2005; free source at time of writing) find inflexible manualisation of motivational approaches associated with worse outcomes. Related study above. For discussion click and scroll down to highlighted heading.

R One-off workshop training is not enough (2005). After this popular training format, retaining psychosocial therapy skills in addiction treatment requires follow-up consultation, supervision or feedback, and trainees’ self-assessments cannot be relied on to assess their progress. Related studies (1 2) above and reviews (1 2 3) below. For discussion click and scroll down to highlighted heading.

R The importance of supervision (2011). Systematic and expert continuing supervision emerged as a key to newly introduced psychosocial treatments actually improving practice and outcomes in specialist substance use treatment settings. However, not all trainees ‘get it’: “what was striking was that trainees whose attitudes to treatment were not conducive to adopting a motivational approach benefited relatively little even from the extended training and supervision”. Related studies (1 2) above and reviews above and below (1 2). For discussion click and scroll down to highlighted heading.

R Motivational interviewing training works best with post-workshop coaching (2013). Synthesis of findings on training clinicians (broadly defined and including but not limited to substance use) in motivational interviewing finds it does develop competence, especially when supplemented by coaching/supervision based on feeding back trainees’ actual performance. Given motivated trainees, initial training can be via books or videos rather than face-to-face workshops. Related studies (1 2) and reviews (1 2) above and review below. For discussion click and scroll down to highlighted heading.

R Sustaining motivational interviewing skills after training (2014; free source at time of writing). Studies mainly but not only of substance use treatment show that retaining motivational interviewing competence after training requires follow-up feedback and/or coaching – at least three to four sessions over a six-month period. Just offering these is not enough – trainees have to attend. Related studies (1 2) and reviews (1 2 3) above. For discussion click and scroll down to highlighted heading.

G Implementing NICE-recommended psychosocial interventions ([UK] National Treatment Agency for Substance Misuse, 2010). Commissioned from British Psychological Society. Includes generic and specific competencies and training/supervision methods for the main therapies recommended by the UK’s health intervention assessor.

G Clinical supervision and professional development of substance use counsellors ([US] Substance Abuse and Mental Health Services Administration, 2009). US guidance on supervision methods and models, cultural competence, ethical and legal issues, and performance monitoring, plus an implementation guide for managers. Web page also gives access to the literature review on which the advice was based, plus updates to 2012.

G Skills and abilities needed for clinical supervision ([US] Substance Abuse and Mental Health Services Administration, 2007). US guidance on competencies needed for effective clinical supervision in substance use disorder treatment, including a step-by-step guide to implementing comprehensive supervisory training and workforce development. See also US checklist of competencies (2017; described here) for people with personal experience of substance use problems who are supervising peer supporters with similar experience.

G How to use client progress measures in the supervision of counsellors (2014; free source at time of writing). Thoughtful suggestions on how to prompt staff development by incorporating discussion of how their clients are progressing in the clinical supervision of therapists and counsellors. Not specific to substance use but applicable across therapy and counselling. Related study above.

G Staff selection, training and supervision for group therapy ([US] Substance Abuse and Mental Health Services Administration, 2005). Consensus US guidance on the different types of groups, how to organise and lead them, desirable staff attributes, and staff training and supervision. Related guidance below.

G How to train and supervise addiction counsellors to deliver group cognitive-behavioural therapy (2013; free source at time of writing). Based on experience in US addiction treatment settings in developing and evaluating group cognitive-behavioural therapy programmes for depression and substance use. Related guidance above.

more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page. See also hot topic on individualising treatment.

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