For... For a variety of reasons service users tend not to stick to a planned programme and so it makes sense to let the therapy sessions evolve from one to the next. Doing this allows the therapist to individualise the focus of the intervention and respond to their service user’s changing needs. Against... Structure is about having a set of core components, not slavishly following a protocol. This means that the practitioner can set the agenda from an agreed understanding of where their service user is at and where they want to be. Without structure, sessions commonly drift into aimless chat. The point to underline about Social Behaviour and Network Therapy is that it can be used flexibly with most addiction problems. The article cited below highlights the need to be flexible in the application of structured interventions, particularly with hard-to-reach groups. It describes interviews with practitioners trained to deliver Motivational Enhancement Therapy and Social Behaviour and Network Therapy with looked-after children. There are different reasons that hard-to-reach groups are hard to reach, but what they have in common is that they are unsure that they want to be reached or actively avoid it. It is good to learn from the more extreme examples... The more damaged the relationships that a service user has, the harder for them to believe that practitioners will be helpful. Empathy, perseverance and providing both emotional and practical support which feels to be unconditional are paramount. Therapy sessions can be very practical, for example going for a walk or visiting a gallery, while discussing and planning the next steps. Substance misuse occurs in a wider context of risky behaviour and comorbidity which might be a more pressing concern for a service user and might best be the focus of the intervention. Find the full text of the article here… Alderson H, Brown R, Copello A, Kaner E, Tober G, Lingam R and McGovern R (2019) The key therapeutic factors needed to deliver behavioural change interventions to decrease risky substance use (drug and alcohol) for looked after children and care leavers: a qualitative exploration with young people, carers and front-line workers. BMC Medical Research Methodology 19, 38  doi.org/10.1186/s12874-019-0674-3

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