How do substance abusers and their significant others experience the re‐entry phase of therapeutic community treatment: a qualitative study1

Transition to re‐entry (aftercare) is a stressful event for therapeutic community residents. While several authors agree on the importance of social support during reintegration, few studies have focused on the experiences of re‐entry clients themselves and their significant others during this period. Using a case‐study design, the present study examines the re‐entry process of four TC‐residents and three of their social network members during a six‐month period, starting at the time of their transfer to the halfway house. Clients and their significant others have mixed feelings about the reintegration period, although both are mainly positive. Clients report difficulties in leaving behind the TC‐mentality and building up a stable social network; they are surprised about the frequent contacts with substance (ab)use in mainstream society. Significant others misjudge clients’ feelings about transition and relapse. Many significant others have a positive attitude towards the use of substances. The tendency in mainstream society to increasingly accept the use of substances intensifies clients’ need for early guidance in building up stable supportive networks. Significant others need well‐grounded information on the reintegration process and on relapse.     

An introduction to research on the social impact of the therapeutic community for addiction

An introduction to the issue of research on the social impact of the Therapeutic Community for Addiction (TC) is presented. The TC is argued to originate in 1957 in the California utopian community of Synanon, although earlier antecedents are recognised. The direct scientific influence on the development of Synanon is documented and traced to the discipline of sociology and the social research tradition. The breaking with the authoritarian style of Synanon is seen as a key process in the evolution of the TC. Social innovations created by the TC movement include interracial and interethnic living groups as well as the instilling of democracy in the relations of caring in the state institutions and the civil society. The issues of after-care and the re-entry phase of the TC client to society are seen as the point where the social impact of the TC can begin to be traced. The integration of the TC into larger treatment systems is discussed, both in its positive and negative consequences to the social movement. Historical research needs to be extended beyond familiar sources into the 'grey literature' of TCs and their umbrella organisations. Also, the need to go beyond research that provides an understanding of the past history of the TC is acknowledged. A call for present-oriented sociological research on the impact of the TC on the social networks of clients in re-entry and on socially excluded segments of society that would revitalise the movement is concluded.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

Unconscious sequences in child protection work: case studies of professionals' experiences of child removal

At a time of increasing calls for a return to relationship‐based practice, this paper presents qualitative research findings regarding the effects of more coercive and less coercive interventions on relationships between social workers and parents. Its context is the use, in England, of investigations of alleged child abuse (more coercive) versus initial assessments (less coercive, and potentially leading to family support services). Methods were based on 23 case studies involving interviews of both parent and social worker. The paper concludes that the less coercive initial assessments, combined with child welfare concerns that were perceived as less serious, provided the context for good working relationships between parent and worker. However, it is suggested that these conditions were not a prerequisite for good relationships. Worker skill was of significant importance, and good relationships were seen to be possible in a variety of procedural contexts. Comparisons are made with accounts of the therapeutic alliance in the counselling and psychotherapy literature.     

AN EXPLORATION OF THE THERAPEUTIC RELATIONSHIP AND COUNSELLING OUTCOMES IN A PROBLEM GAMBLING COUNSELLING SERVICE

This study examined the relationship between a number of counselling process variables thought to influence counselling outcomes in a sample of 150 clients undertaking short‐term counselling in the state‐wide government funded Gambler's Help problem gambling counselling services in Victoria, Australia. Factors measured included psychosocial well‐being of clients prior to and after counselling, client readiness to change, self‐reported gambling activity levels before and after counselling, self‐assessment of current gambling behaviour, strength of therapeutic alliance, self‐reported counselling outcomes achieved in the area of symptoms, life matters, and related problems and a measure of client satisfaction with the service. The therapeutic alliance was found to have the strongest predictive power with respect to the level of problem resolution achieved by clients across all but one of the problem areas. The implications of these findings for clinical social work practice and education of practitioners are noted.     

Seeing Like a DSM: Therapeutic Governance,Welfare, and Social Workers

This article suggests considering the processes affiliated with therapeutic governance through the relationships between social workers and prisoners’ wives. Research findings reveal unique practices of therapeutic governance that in turn maintain the state gazes that help regulate welfare individuals and populations: the invention of psychiatric categories and the conviction that they appear in the hegemonic psychiatric classification manual (DSM); definition of two selected emotions (shame and anger) as critical to therapeutic subjectivity; the internalization of a specific femininity expressed, inter alia, by “therapeutic clothing” and the absence of “grotesque excess,” as an indicator of recovery and normal subjectivity, which in turn increases the chances of receiving financial assistance from the welfare authorities. The discussion section maps out the unique research contributions of the article to the links between welfare, therapy, and surveillance in the everyday life of subaltern populations.     

Reconceptualizing Substance Abuse Treatment in Therapeutic Communities: Resiliency Theory and the Role of Social Work Practitioners

ABSTRACT

Although therapeutic communities (TC) have achieved promising results in the treatment of substance abusers, several areas have been identified which might further enhance TC treatment effectiveness. Two of these, resiliency theory and the role of social work practitioners, are discussed. Resiliency theory provides a framework for re-conceptualizing interventions as they apply to therapeutic communities. Resiliency is explicated and illustrated via a case study of a therapeutic community TROSA (Triangle Residential Options for Substance Abusers), a non-profit TC in Durham, North Carolina. A number of contributions that social work practitioners can make to TCs are described.     

Quality of experience in residential care programmes: Retrospective perspectives of former youth participants

This exploratory study examined perceptions of care quality within parent‐pay youth treatment programmes such as therapeutic boarding schools, residential treatment centres, wilderness therapy programmes, and intensive outpatient programmes. Reflecting on their personal experiences as youths, 214 adults reported on a total of 75 different treatment settings. Two indices developed for this study measured participants' perceptions of quality of experience and the totalistic programme characteristics of their care settings. Regression analyses and ANOVA tests of means indicated a negative relationship between totalistic programme characteristics and quality of experience index scores. Significant relationships were not found between quality of experience and forcible transport, intake decade, or the amount of time in treatment.     

Editorial collaborators

Traditionally, the bioequivalence of a generic drug with the innovator's product is assessed by comparing their pharmacokinetic profiles determined from the blood or plasma concentration-time curves. This method may only be applicable to formulations where blood drug or metabolites levels adequately characterize absorption and metabolism. For non-systematic drugs categorized by the lack of systemic presence, such as metered dose inhalers (MDI), anti-ulcer agents and topical antifungals and vaginal antifungals, new definition of therapeutic equivalency and criteria for acceptance should be used. When pharmacologic effects of the drugs can be easily measured, pharmacodynamic effect studies can be used to assess the therapeutic equivalence of non-systemic drugs. When analytical methods or other tests cannot be developed to permit use of the pharmacodynamic method, clinical trials to compare one or several clinical endpoints may be the only suitable method to establishing therapeutic equivalence. In this paper we evaluate by Monte-Carlo simulations the fixed sample performances of some two one-sided tests procedures which may be used to assess the therapeutic equivalence of non-systemic drugs with binary clinical endpoints. Formulae of sample size determination for therapeutic equivalence clinical trials are also given.     

Co-research interview—collaborative way to learn from experience

Co-research interview developed by Tom Andersen and colleagues is a collaborative way of evaluating therapeutic processes that value the experiences of both clients and professionals. This article describes our experiences and thoughts on this interview method. We present the interview structure and give suggestions on how to conduct the interview. We also present applications of the interview method and engage in a dialogue among ourselves about our experiences with these interviews.