Treatment as a transformative process

1
Treatment as a transformative process

• Ass. Professor
• Kerstin Svensson
• School of Social Work,
• Lund University
• Sweden
• kerstin.svensson_at_soch.lu.se

• Ass. Professor
• Eva Johnsson
• School of Health Sciences
• and Social Work,
• Växjö university
• Sweden
• eva.johnsson_at_vxu.se

2
Aims

• Describe the transformation process in treatment
• Highlight organisational and individual aspects
  in the process
• Problematise how to measure results in treatment

3
Material

• Mainly based on
• Two parallell studies of co-operation between
  social workers in social services and clients in
  coercive care in Sweden
• 13 interviews with social workers
• 10 interviews with clients in coercive care
• Article in swedish Tvånget i tvångsvården,
  Sociologisk forskning no 3, 2006

4
Clients in organisational setting

• Human service organisations
• Human raw material is processed
• The organisation can not act, the actors are
  human and in interaction with the human raw
  material
• The organisation serves both the client and
  society
• Clients in HSOs are raw material, parts in
  interaction, aim and task and more
• To sum up Clients are both objects and subjects

5
Types of Human Service Organisations (Hazenf
eld 1983)

• People processing
• transform clients by social labelling and
  classification that could be base for
  interventions
• People sustaining
• maintain welfare, prevent risks, cares for
  people without ambition to change
• People changing
• alter personal attributes of clients in order
  to improve their well-being

6
Substance abuse treatment in people changing
human service organisations

• Aims to change substance abusers to
• non-users or users.
• The organisation has methods and measures
• Clients has to adjust
• The treatment process is transformative
• The process can be followed step-by-step

7
Transformation in interaction

• Randall Collins (2004) Interaction ritual chains
• Actors are created in the situation
• Interaction is ritualised
• Treatmeant is ritualised interaction
• Identity comes from experienced interaction
• Treatment aims at changing identity

8
The transformation process

• Treatment is initiated
• Assessment, classification, categorisation
• Position as a client an object
• Adjusting to the organisation
• Services and intervention technologies
• Preparing for a new life - re-subjectification
• Treatment is finished

9
Treatment is initiated

• Client by that time, I hadnt finished, I
  just wasnt ready. And they took me in to custody
  when I I was not ready
• Client My situation was intolerable out there
  I couldnt even make what I needed to feel good,
  I wasnt in health
• Social worker He was suicidal. He had totally
  resignated

10
Assessment, classification, categorisation

• Client We came there, said hallo and so. I had
  people around me all the time. Then we entered
  the hall, there was a case with clothes. I had to
  provide a specimen of urine and then I should
  shower. When I came back, my clothes where taken.
  I had to wear their clothes. I had to take the
  prison uniform. I thought what the hell is
  this? I would say for me it was a shocking
  example!

11
Position as a client an object

• Client Of course you react. It is human to
  react. But they do not listen. Either they say it
  is withdrawal symptoms or they say that it is an
  reaction from the drug, you have no chance.
• Social worker After about half the time here,
  he started to open up he started to talk more
  with the other clients, engaging in activities,
  therapy groups and so

12
Adjusting to the organisation

• Client We have activities every Tuesday and
  sometimes in the week end. We are going swiming
  on tuesdays and on week ends we can suggest
  something, and then they try to make it. They are
  keen to fulfill our suggestions. That is a very
  god thing
• Client It is as they say, if I feel at home, I
  will improve and develop

13
Services and intervention technologies

• Client There are groups where you can sit and
  talk
• Client You just do what ordinary people do.
  Its nothing strange with that. Its just not to
  take drugs
• Client You do not really do anything here.
  Sometimes you can take a walk in the park. It
  is very slow.
• Socialworker He is one of my thirty cases, I
  have others too, you know

14
Preparing for a new life -
re-subjectification

• Client I participated in a group. We talked
  about addiction and how to stay sober. I liked it
  and fell very confident talking about my problems
  to people who listened. It helped me a lot and I
  am still sober.
• Social worker I had to remind him about getting
  an appartment, and finally he did. He dont need
  me anymore, that is good.
• Client I do not think about the treatment,
  the only time I do think about it is when people
  ask. I am as everyone else.

15
Treatment is finished

• Client If they hadnt taken me in to care, I
  wouldnt be alive today
• Client Treatment was good for me. It made me
  think my life trough.
• Social worker I call him from time to time to
  see how he is doing.

16
Treatment as a transformative process

• Treatment is initiated
• Assessment, classification, categorisation
• Position as a client an object
• Adjusting to the organisation
• Services and intervention technologies
• Preparing for a new life - re-subjectification
• Treatment is finished
• Where do we measure results?