At the heart of addiction treatment lies client–therapist relationships, across psychosocial therapies a stronger influence on how well clients do than the type of therapy. A collection starting with the analyses most recently added or updated, totalling today 81 documents.
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DOCUMENT 2013 HTM file
Sometimes best to break the rules
Motivational interviewing’s ‘Do not dos’ like avoiding confrontation were intended to sidestep the traps which provoke clients to dig in their heels or disengage. Imagine then the upset of discovering that in certain circumstances, the opposite is the case; the explanation appeared to lie in coming across as ‘genuine’.
STUDY 1970 HTM file
Frontiers of alcoholism
Later to become founding director of the US National Institute on Alcohol Abuse and Alcoholism, in the late 1950s Dr Morris Chafetz of the Massachusetts General Hospital conducted a remarkable series of studies which proved that an alcohol clinic's intake and performance can be transformed by the simple application of empathy and organisation.
STUDY 1981 HTM file
Interpersonal functioning of alcoholism counselors and treatment outcome
Seminal US study which found that the therapy-related social skills of alcohol counsellors were strongly related to how many of their patients relapsed in the two years after leaving inpatient treatment.
Seminal English study which turned the spotlight on organisational factors in the development of a positive attitude to working with problem drinkers, in particular the availability of experience in working with these patients and the support of experienced colleagues. Without these the effects of training are less and less well sustained.
From the comprehensive treatment process data collected by a major national US study emerges the important lesson that retention in itself is not an active ingredient in post-treatment outcomes but reflects influences such having one's needs met (especially important for women) and developing a good relationship with the service and your key worker.
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.
It should have improved relationships between counsellors and clients and between counsellors and their clinics, but a sophisticated system for feeding back client progress made no positive difference on any of these measures. A later study helped establish why: counsellors were not told which patient the feedback related to and what they might do about it.
How to get parents more engaged in becoming a positive influence over their seriously delinquent drug abusing teenagers through family therapy integrated in to a US juvenile drug court. Some of the therapist tactics expected to work did deepen engagement, others did not.
The drive in Britain to increase drug treatment exits will mean more patients detoxifying and in need of being linked to effective follow-on care to safeguard their lives and their recovery. Evidence from the USA that a simple counselling intervention can help make that vital link.
This review encapsulates the range of treatment assessment and improvement tools developed over decades by the Texas Christian University, widely recognised as the most comprehensive and systematic attempt to map the processes involved in treatment and to link these to interventions to improve outcomes for the client.
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