Motion: 'informal discussion, or chat, is a crucial part of building a working alliance between practitioner and service user'

For...

You need to establish rapport before you can talk about the substance use and its treatment. If there is no rapport then there is no point to any kind of intervention; service users will not take in anything that is said to them, they will probably dislike their practitioner, and are likely to drop out.

Against...

Establishing rapport is important and needs to be part of dealing with the problem the service user wants help with. It is no good wasting time just trying to strike up some rapport. Service users want to know that they are going to get the help they need and that their practitioner has that as their focus.

For... Talking about things that are neutral and do not cause anxiety for a service user is important, especially in the early stages of an intervention, in order to create a trusting relationship and to break down any barriers that might exist. Without chat practitioners appear distant and can be felt as looking down on their service user. Against... Beyond initial introductions, informal discussion is a waste of therapy time. It is important to stick to treatment protocols that are associated with change. It is quite possible that service users and practitioners have different views on all kinds of issues and irrelevant chat can be felt as showing disinterest in a service user’s problems. The value of informal discussion within treatment sessions has long been debated. Practitioners talking about personal reactions or experiences that are similar to their service user’s is seen as potentially beneficial in that it helps practitioners convey genuineness, authentic concern and build a working alliance. This kind of self-disclosure is fundamental to the working of twelve step groups. On the other hand, talking about things that are not immediately related to a service user’s treatment may appear insensitive or irrelevant and thereby undermine the therapeutic alliance and waste time. In this study 41 practitioners were trained to use motivational techniques and 35 delivered ‘counselling as usual’; 736 treatment sessions were tape recorded. Most irrelevant chat involved disclosures of personal information (28%) such as common interests e.g., pets, vacation preferences, activities (e.g., exercise, shopping), background e.g., ethnicity, religion, and experiences with family and friends. Practitioners also disclosed their own prior history of health problems (7%) or psychological and interpersonal difficulties (6%) and offered their unsolicited opinion (22%) about many different topics e.g., the quality of restaurants, other treatment providers, current events or news (9%), work-related problems or stressors (6%), and their professional background or history (3%). Informal discussion, or chat, was negatively associated with in-session change in motivation to reduce or stop using drugs and alcohol even though it may increase the feeling of friendship between practitioner and service user. Find the full text of the article here…
Martino S, Ball SA, Nich C, Frankforter TL and Carroll KM (2009) Informal Discussions in Substance Abuse Treatment Sessions. J Substance Abuse Treatment 36: 366–375 doi:10.1016/j.jsat.2008.08.003