Counselling problem drinkers: The realm of specialists. Alcoholics Anonymous or generic counsellors?

Abstract

A study was carried out to investigate counsellors' attitudes and experiences in working with people with drinking problems and counsellors' understanding of Alcoholics Anonymous as a helping agent. Ninety-four counsellors responded to a questionnaire about their work with people with drinking problems and their knowledge of AA. Generic counsellors tended not to feel competent working with clients with alcohol problems. Feelings of competence increased with greater experience of the client group and, to a lesser extent, with more hours of specialist training. It was found that counsellors whose intake of alcohol amounted to more than eight units per week weTe less likely to take on clients with alcohol problems than were those who drank less. Counsellors usually had some knowledge of AA but had little understanding of the 12-step programme that forms the basis of recovey for alcoholics as described by AA. They were, however, in favour of clients attending AA as an adjunct to individual counselling.

Therapists’ understandings and experiences of working with clients with problems of addiction: A pilot study using Q methodology

“…The need for supervision and further training on these issues is indicated by participants' expressed feelings and attitudes towards addictive clients with 'difficult' behaviour and the challenges they present to therapists' competence. Previous research indicates that therapists' feelings of competence increase with greater experience of this client group and, to a lesser extent, with specialist training (Wheeler & Turner, 1997). This pilot study suggests that examination of therapists' beliefs and values about addiction would therefore be a valuable addition to training.…”

“…Considering that previous research indicates that clients tend to assimilate their therapists’ values (Kelly & Strupp, ), there is a need for therapists to be aware of the potential impact of their values on their clients, and also of the potential of value similarity or divergence to affect the therapeutic process and hence outcome. The need for supervision and further training on these issues is indicated by participants’ expressed feelings and attitudes towards addictive clients with ‘difficult’ behaviour and the challenges they present to therapists’ competence. Previous research indicates that therapists’ feelings of competence increase with greater experience of this client group and, to a lesser extent, with specialist training (Wheeler & Turner, ). This pilot study suggests that examination of therapists’ beliefs and values about addiction would therefore be a valuable addition to training. Agencies need to consider how to handle potential conflict when a therapist's understanding of and approach to addiction differs from the philosophy of the agency. From an agency's perspective, acknowledging all these particular challenges would suggest a need to provide opportunities for in-depth supervision and staff development with respect to therapists’ values and beliefs. This pilot study has shown that exploring the complex relationships between theoretical orientation, personal values and beliefs, and actual therapeutic practice (Najavits, ; Poznanski & McLennan, ) constitutes an important area for further research. Considering that one objective of this pilot study has been to test the feasibility of using Q methodology in this study and more broadly in qualitative research in psychotherapy, we hope that this study will encourage other researchers to explore Q methodology.As a pilot study with restricted scope, this project has several limitations.…”

“…They also correspond to the contemporary approach of 'assimilative integration', described in Norcross et al (2005) as an endorsement of a broad orientation, grounded in one system of psychotherapy but coupled with a willingness to incorporate practices and views from other systems selectively, and adapting the approach to meet client needs. However, incorporating ideas from different theoretical approaches, with different ontological and epistemological bases and different practices, may result in difficulties for therapists when their understanding and approach to therapy conflicts with the philosophy or policy of the agency where they work (as seen in factor A), and my result in confusion for the client (McCrady, 1994;Wheeler & Turner, 1997).…”

“…Negative feelings about clients can be expressed in relief when 'difficult' clients drop out of therapy, in doubting one's competence as a therapist (factor C), or in a lack of compassion towards clients (factor B). Indeed, the literature on attitudes to clients with problems of addiction suggests that they are perceived as more 'difficult' than other clients; they present challenges to therapists' competence (Najavits et al, 1995(Najavits et al, , 2000Wheeler & Turner, 1997) and they may evoke difficult countertransference feelings (Rodríguez de la Sierra, 2002;Vannicelli, 2001). At the same time, some positive feelings of empathy and caring are also present (Najavits et al, 1995).…”

“…Research focusing on therapists’ understandings, beliefs, attitudes, and experiences of working with clients affected by addiction is limited (Najavits et al, ; Wheeler & Turner, ). Although studies (Hshieh & Srebalus, ; Humphreys et al, ; Moyers & Miller, ; Thombs & Osborn, ; Toriello & Leierer, ) encompass a range of conceptualisations of and beliefs about addiction, they originate in the USA and tend to reflect the prevailing disease and AA/12‐step models.…”