Helpful people research
selected articles
What is good practice?
Our opinion
How therapists behave makes all the difference to treatment outcomes. Research into what makes an effective practitioner has produced remarkably consistent findings and it is clear that the way practitioners deliver a treatment makes a bigger difference than the treatment itself. Being friendly, respectful and having an understanding of addiction problems is crucial to any interactions.
Classic study :: How do you engage people in treatment?
Chafetz ME, Blane HT, Abram HS, Golner J, Lacy E, McCourt WF, Clark E and Meyers W (1962) Establishing treatment relations with alcoholics. Journal of Nervous and Mental Disease 134: 395-409
The researchers looked at what happened when people with alcohol problems attending an Emergency Room were seen by the regular staff compared to staff from an alcohol agency. The first chart shows 65% of those seen by specialist alcohol staff attended the alcohol service for an initial appointment compared to 5.4% of those seen by ER staff. The second chart shows those making contact of any kind after the Emergency Room encounter.
It is all about being nice, being optimistic and showing expertise that gives confidence that you can help.
Are practitioners born effective or do they learn to be?
Our opinion
Treatment outcomes vary quite markedly between therapists and there is no reason to suppose that this is not the case in most services. A strong clinical governance programme is perhaps the way to minimise variation. Most practitioners can learn to be effective given the right support.
The effectiveness of nine well qualified and experienced therapists was judged against a collection of outcome measures: Addiction Severity Index (ASI) (drug use, employment, legal status, psychiatric status), Beck Depression Inventory, a symptom checklist (SCL90) and a neuroticism scale. Outcomes were averaged across each practitioner’s caseload. The chart shows how variable the practitioners prove to be in helping people to get better - notice that the ninth practitioner consistently made people worse.
Note that measures of practitioners’ personal qualities, interest in helping, psychological health and skill correlated with their Helping Alliance Questionnaire score (r=0.74), which in turn correlated across all outcomes (r=0.65) and with adherence to treatment manuals (r=0.44). In other words all these things have an impact on outcome.
Landmark study :: Are all therapists equally effective?
Luborsky L, McLellan T, Woody GE, O'Brien CP and Auerbach A (1985) Therapist Success and Its Determinants. Archives of General Psychiatry 42: 602-611
What do service users want?
Our opinion
Service users want a ‘normal’ relationship with a knowledgeable practitioner. This might seem obvious but it raises sometimes difficult questions about dress codes, self-disclosure with service users, how to address each other, and what language is appropriate.
Important study :: What sort of practitioner do service users want?
Laugharne R, Priebe S, Chevalier A, Paton C, Sharma RK, O’Kelly A and Richards G (2021) The sociocultural and behavioural characteristics that patients want in psychiatrists: cross-sectional survey of patients’ views. British Journal of Psychiatry Bulletin 45: 158–163 doi:10.1192/bjb.2020.115
This study asked 132 service users of mental health services what sociocultural characteristics they see as important in their psychiatrist. If repeated with addiction practitioners the results may be different, but they may well be very similar.
The four top ranking characteristics are not unique to any one profession or any given role, with the exception of having up to date medical knowledge (ranked 2nd most important), the characteristics are generic. 79% of service users wanted a practitioner who had been qualified for some time, meaning was experienced, and 73% wanted someone 40-55yrs. Otherwise the large majority rated gender, religion, social background or marital status low in importance. About a quarter of women expressed a preference to see a female or a (smaller number) male psychiatrist.
It is important that services strive to meet the preferences of all service users not just the majority, however large that might be.
Alexander LB, Barber JP, Luborsky L, Crits-Cristoph P and Auerbach A (1993) On What Bases Do Patients Choose Their Therapists? Journal of Psychotherapy Practice and Research 2: 135-146
Necessarily based on an artificial situation, this study is worth noting. Forty participants chose one of two therapists with whom they had two treatment sessions. The researchers conclude that the choice was made on the strength of their working alliance and liking for each other rather than demographic characteristics. It was noted that, from a psychological perspective, people like to have choices but not to make them.