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Home > Alcohol Matrix cell B4: Practitioners - psychosocial therapies.

Drug and Alcohol Findings. (2017) Alcohol Matrix cell B4: Practitioners - psychosocial therapies. London: Drug and Alcohol Findings and the Substance Misuse Skills Consortium. 7 p.

PDF (Alcohol Matrix cell B4)


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 ‘psychosocial’ therapies in which interaction is intended to be the main active ingredient. These range in form from brief advice and counselling to extended outpatient therapies and all-embracing residential communities where clients stay for months. In their content and techniques therapies also differ, varying for example from the deep probing of psychoanalysis to the more skills-based cognitive-behavioural approaches. 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 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. We have seen this generally across treatment and in respect of medical treatments. Unsurprisingly, the evidence is strongest for psychosocial therapies, when the structured enactment of the therapist-client relationship is the treatment, forcing attention to it even in studies designed to minimise such influences. In this cell we focus on client-worker relationships, and on whether some therapists are more successful because they more strongly forge the right kind of relationships – ‘therapeutic’ 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 earlier in this matrix in the context of the influence of practitioners in medically-based 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 organisational factors links had been taken into account) between abstinence and the client-worker relationship.

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