The Alcohol Treatment Matrix is concerned with the treatment of alcohol-related problems among adults (another deals with drug-related problems). It maps the treatment universe and for each sub-territory (a cell) lists the most important UK-relevant research and guidance. Across the top, columns move from specific interventions through how their impacts are affected by the widening contexts of practitioners, management, the organisation, and whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. Inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level. 

What is cell B4 about?

Every treatment involves direct or indirect human interaction, but this cell is about treatments in which interaction is intended to be the main active ingredient – ‘psychosocial’, or more colloquially, ‘talking’ therapies. Based on varied understandings of how dependence arises and how it can be overcome or ameliorated, they attempt to change how the patient behaves via their beliefs and attitudes, how they relate to others, and how others relate to them, or directly by ‘shaping’ behaviour through rewards and sanctions.

These differences between therapies have been tested and contested and occupied the lion’s share of research time, but as long as it is a well structured, bona fide treatment which ‘makes sense’ to patient and therapist, the ‘common factors’ shared by supposedly distinct therapies (on which see “Where should I start?” in cell A4) seem more critical to their success.

For patients and researchers, how the therapist relates to the client is the main embodiment of the common factors shared by therapies, and the most salient way they affect engagement and outcomes. In cell B2 we have seen this generally across treatment and in cell B3 respect of medical treatments. Unsurprisingly, the evidence is stronger still for psychosocial therapies, where the structured enactment of the therapist–client relationship is the treatment, forcing attention to it even in studies (listed above) designed to minimise such influences.

In this cell we focus on client–worker relationships, and on whether some practitioners are more successful because they more strongly forge the right kind of relationships. Before moving into that territory, a reminder that therapists and counsellors typically work in organisations which limit or enhance their ability to maximise client progress, an issue explored cell B3 in the context of medical treatments. The same issue will emerge in this cell from a study (described in the supplementary text towards the end of this ‘bite’) which identified significant relationships between abstinence and the characteristics of the treatment organisation, but not (once these characteristics had been taken into account) between abstinence and the client–worker relationship.