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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’.
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.
For the first time this Canadian randomised study has shown that training probation officers in the risk-need-responsivity model of offender supervision can not only improve their skills and sharpen their practice, but also reduce the recidivism of the offenders they supervise, among whom substance use was a major issue.
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.
As this review comments, people treated for substance use often remain precariously balanced between recovery and relapse. Widely seen as valuable if not essential, aftercare is nevertheless more the exception than the rule. How to reverse that ratio is the issue addressed by these leading US analysts.
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.
STUDY 2011 HTM file
Therapist effectiveness: implications for accountability and patient care
1 in 6 US therapists (mainly not specialising in substance use) typically ended up with clients whose substance use problems were significantly worse than when they started therapy, an indication perhaps that social workers and mental health counsellors find these issues especially hard to deal with.
Compared to basic drug education, it should at least have moderated current use, but this attempt to deploy motivational interviewing as an across-the-board prevention strategy among college students in London neither did that, nor did it prevent non-users starting to use, negative findings which raise interesting questions.
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