Home > Report proposes a new approach to working with drug users.

Fanagan, Sarah (2007) Report proposes a new approach to working with drug users. Drugnet Ireland , Issue 22, Summer 2007 , p. 17.

[img]
Preview
PDF (Drugnet Ireland, issue 22) - Published Version
764kB

In January 2007 Kilbarrack Coast Community Programme (KCCP) published a report entitled Forging a new template: proposing a more effective way of working with drug users.1 Declan Byrne, the author of the report, has worked with KCCP since December 2000.  He was awarded a masters degree in addiction studies from Dublin Business School (DBS) in 2005.  This report is the culmination of his practical and academic experiences. 

In a foreword to the report, Dr Rick Loose of DBS describes addiction and explains the importance of creating a transferential space in order to treat it.  During treatment, addicts are asked to abstain from, or put a limit to, the substance they have been using.  When asked to give up or reduce their intake of the problem substance which gives them pleasure (or stops pain), addicts will often come to depend on a substitute mechanism.  Dependency on drugs or alcohol is transformed into a dependency on staff and/or the treatment centre.  Addicts demand from the counsellor (or institution) something which drugs or alcohol had previously given them.  They want to regain some of the lost immediacy or satisfaction via the transference relationship.  

Addiction treatment relationships involve emotional expressions (demands for recognition, trying to please, being good, wanting to be loved, accusation, irritation, aggression, transgression, behaving badly etc.) which are signs of the pathology of the client.  These emotional expressions are the essence of addiction treatment.  The only way for addicts to recover is via verbalisation within a relationship where very difficult and anxiety-provoking experiences can be articulated and worked through.  

It is in the very nature of addiction to undermine the pact that exists between people.  This is what counsellors have to withstand and when this becomes problematic it can lead to counter-transference.  It often happens that staff are idealised by addicts.  At an unconscious level staff members may identify with this idealisation – there is a need in them to be admired by their clients.  The treatment can become destructive if the counsellor’s need feeds into the pathology of the client.  This will lead to a therapeutic deadlock and the client will be forced to remain dependent on the counsellor/institution. 

Loose argues that the creation and maintenance of a space of transference within society is essential.  Popular culture advocates the immediacy of enjoyment which means that there is less space for dissatisfaction, desire and the social bond.  This is the kind of culture that becomes less demanding of its subjects in terms of making them responsible for finding solutions to their own suffering and increasingly forces external solutions on them.  

In the main body of the report, KCCP is used as a case study ‘to demonstrate the need for change in the way we work with problematic drug users’.  The varied lifestyles and circumstances of the programme participants are illustrated using the data from a general questionnaire administered to the 16 participants on the programme in March 2005.  Detailed accounts of the experiences of three participants are provided by way of semi-structured interview, life history and treatment history.  It is clear from these examples that the participants have different histories and reasons for taking drugs.  As a result of his own work with clients and his reading of the academic literature (see report for details), the author advocates an approach to treatment in which the treatment programme is tailored to meet the needs of the individual, in so far as is possible.  He highlights the necessity of working with the transference that occurs in the treatment of addiction and suggests that doing so could significantly increase the effectiveness of KCCP. 

The author points out that KCCP will not be in a position to employ trained psychotherapists or psychoanalysts in the short to medium term.  However, he suggests that a structured training programme could enable staff to manage the transference/counter-transference in order to help their clients.  In June 2005 KCCP held a half-day training course on the issue of transference/counter-transference. This was seen as a first step in increasing awareness of the issue among staff.  The author argues that the Health Service Executive (HSE) must take more responsibility for the running of community drugs programmes.  ‘By taking a more hands-on approach, they could ensure that all staff are professionally trained and that clinical supervision is provided.’ 

The author’s proposed new template

·         The management of transference should be placed at the centre of KCCP’s programme.

·         Training in transference/counter-transference should be prioritised and funded for all staff working with clients.

·         External supervision must be provided for staff.

·         Additional funding should be sought to employ a psychotherapist to work with clients who have severe problems, particularly those with dual diagnosis and trauma histories.

 

1. Byrne D (2007) Forging a new template: proposing a more effective way of working with drug users. Dublin: Kilbarrack Coast Community Programme Ltd.

 

Item Type:Article
Issue Title:Issue 22, Summer 2007
Date:April 2007
Page Range:p. 17
Publisher:Health Research Board
Volume:Issue 22, Summer 2007
EndNote:View
Accession Number:HRB (Available)
Subjects:HJ Treatment method > Psychosocial treatment method
VA Geographic area > Europe > Ireland > Dublin
MP-MR Policy, planning, economics, work and social services > Policy > Policy on drugs and alcohol
J Health care, prevention and rehabilitation > Health care programme or facility > Community-based treatment (primary care)

Repository Staff Only: item control page