Turning points in treatment Do the views of the practitioners and clients differ Arne Kristiansen Sc

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Turning points in treatment Do the views of
the practitionersand clients differ?Arne
KristiansenSchool of Social WorkLund
UniversityThe 11th International Symposium
onSubstance Abuse Treatment, Växjö, Sweden,6-8
October 2008
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Three different views

• The relationship orientated view
• The treatment orientated view
• The authoritarian view

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The relationship orientated view

• The importance of a good relationship between the
  practitioners and the clients/users
• The therapeutic alliance
• No differences between clients and practitioners
• Frank Frank, 1991 Valliant, 1983 Wampold,
  2001 Blomqvist, 1991 Jenner, 1992 Kristiansen,
  1999 Börjeson, 2008 Topor Borg, 2008.

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The treatment orientated view

• Emphasize methods and techniques as the most
  important parts of the treatment
• Often related to the concept of evidence-based
  practice
• An approach often argued for by practitioners

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The authoritarian view

• Treatments and practitioners make demands which
  are impossible to live up to (Kristiansen
  Svensson, 2004 Kristiansen, 2005)
• Lack of symptom tolerance
• Differences between clients and practitioners

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The three views shares a problem

• Even if these three views differ from each other
  they share a problem - they only consider the
  context of treatment. If we want to understand
  change from drug abuse the context of treatment
  is not sufficient.
• To understand how change from drug abuse appears,
  we must regard others factors besides treatment
  common factors.
• Research on change from drug abuse which
  considers perspectives of a life-historic
  context, illustrate such factors (Blomqvist,
  1998, 2002 Kristiansen, 1999).
• We must also regard the service user perspective.

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The service users perspective

• Is not only a question of listening to the
  clients.
• It is a question of to regard the clients life
  experiences as a source to important knowledge
  which are necessary to understand the treatment
  process.
• We discovered that the main thing was not to
  give the poor the chance to make their voice
  heard, but to open our ears. It is not about
  empowering the poor, but about humanising
  citizens and institutions. (Tardieu 199975)

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• Free from drugs (Kristiansen, 1999)
• positive social influences
• relationships to people who were not drug
  abusers
• work and lodging.
• Treatment
• relationsships, confidence, community, respect,
  tolerance, engagement, positive expectations

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The reason which makes a person start to change
life is not the same as the reasons that maintain
the change (Kristiansen, 2002).
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• Free from drugs (Kristiansen, 1999)
• positive social influences
• relationships to people who were not drug
  abusers
• work and lodging.
• Treatment
• relationsships, confidence, community, respect,
  tolerance, engagement, positive expectations

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• Youth with problematic life styles (Kristiansen,
  forthcoming)
• work, schools
• new friends, boyfriends and girlfriends
• change of environment
• Nobody mentioned treatment as something that had
  been important for their change

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No treatment is better than what happens after it
(Kristiansen, 2001).
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Relationships, confidence, respect, tolerance,
engagement and positive expectations are
important factors in succesful treatments (Frank
Frank, 1991 Jenner, 1992 Vaillant, 1983).
It is important to notice that many people
leave drug abuse without treatment (Blomqvist,
1998, 2002, 2007 Granfield Cloud,
1999). Understanding change from drug abuse must
regard factors which are not related to the
treatment common factors. Understanding change
from drug abuse must regard the service user
perspective.
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The service user perspective - an essential part
in an evidence based practice.
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Turning points in treatment - Do the views of the
practitioners and clients differ?
The practitioners view is often connected to
treatment context. The clients view is wider and
takes in factors besides the treatment context.
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One risk with the treatment views is that the
focus on the treatment context takes attention
from the fact that drug abuse in many respects is
not a treatment problem, but a social
problem. Successful treatment must have
strategies for the client/user as he or she
finishes the treatment.
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After-care? Human and social rights rights to
have a home, to a meaningful employment, to a
safe income, right to social support and not to
be discriminated because of your background.
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References

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