The process of skills training: A content analysis of evidence-based addiction therapies

Defining the therapeutic relationship in the context of alcohol use, other drug use, and behavior change: Principles and practices

OVERVIEW

This article contributes to knowledge and practice of core processes that are shared by evidence-based alcohol or other drug (AOD) therapies. It is the fourth in a series with this aim, and here we discuss perhaps the most universally acknowledged ingredient of effective therapy - the therapeutic relationship. We consider various related terms and definitions in the literature, but in the present review, we offer a definition that underscores the context of behavior change.

METHOD

This study conducted a literature review and qualitative content analysis to derive a set of principles and practices for facilitating and maintaining the therapeutic relationship. The sources for this review included government-issued practice guidelines, therapy manuals or books, demonstration videos, and peer-reviewed articles (61 sources). The content analysis was performed in NVIVO, and reliability analysis showed moderate agreement between raters (kappa = 0.60).

RESULTS

Six principles and 16 practices were identified. The distribution of principles and practices could be broken into three categories: 1) the facilitation of client behavior change mechanisms (i.e., self-determination, motivation, self-efficacy), 2) partnership considerations (e.g., goal and task alignment), and 3) therapist interpersonal skills (e.g., empathy).

CONCLUSIONS

The therapeutic relationship is foundational to the behavior change process. We frame it as a combination of broader interpersonal considerations and attention to key mechanisms of client behavior change. The present work provides a novel resource for trainees, clinicians, and clinical supervisors interested in fostering therapy relationships with clients in AOD or other behavior change settings.

Goal setting and monitoring with alcohol and other drug use disorders: Principles and practices

INTRODUCTION

This work builds on a small body of literature that explores core processes in psychotherapy, behavior change, and evidence-based alcohol or other drug (AOD) therapies. Here, this paper discusses two separate but dependent processes. The research team defines goal setting and goal monitoring as collaborative processes where clinicians and clients identify and formulate therapeutic goals; actionable objectives; and revisit, measure, and renegotiate these plans via a standardized procedure over time.

METHOD

Study methods included a literature review and qualitative content analysis to derive a set of principles and practices of goal setting and monitoring. The research team used source documents (i.e., literature reviews, therapy manuals, and government-issued practice guidelines) and videos (i.e., therapy demonstration videos), and we performed analyses in NVIVO.

RESULTS

The study identified ten principles and 32 practices. The principles suggest that goal setting and monitoring can be characterized as a collaborative, explicit, and standardized approach to engaging in goal-directed therapeutic work. The term goal-directed therapeutic work connotes a shift toward a more accountable frame for care than has been previously emphasized in the literature. The identified practices were organized into five sub-themes related to goal setting (10 practices), goal monitoring (10 practices), as well as practices specific to mechanisms of goal pursuit and behavior change. These practices involved ways to attend to client self-determination (4 practices), motivation (4 practices), and self-efficacy (4 practices).

CONCLUSIONS

Goal setting and monitoring are a collaborative means of mapping and tracking a course of mutually accountable treatment. The current work is a novel resource for trainees, clinicians, and clinical supervisors interested in care based on evidence-based principles and practices of AOD and other behavior change therapies.

The principles and practices of psychoeducation with alcohol or other drug use disorders: A review and brief guide

OVERVIEW

In the current work, we build upon a small body of literature that delineates cross-cutting factors, or processes, of evidence-based alcohol or other drug (AOD) therapies. Here, we discuss Psychoeducation. We define psychoeducation as a brief process of therapy focused on the communication of varied aspects of disease- and/or treatment-related information.

METHOD

The authors conducted a literature review and qualitative content analysis to derive a set of principles and practices of psychoeducation. The review used source documents (i.e., literature reviews, therapy manuals, and government-issued practice guidelines) and videos (i.e., therapy demonstration videos), and we performed analyses in NVIVO.

RESULTS

The review identified nine principles and 21 practices. Together, the principles suggest that psychoeducation in evidence-based addictions therapies can be characterized as a collaborative approach to teaching, education, or other provision of information. The term collaborative denotes a shift in emphasis from compliance to a more egalitarian partnership focused on meeting individual health needs. Specific practices included ways to transition to psychoeducation (e.g., provide rationale and promote expectancy), teaching methods in psychoeducation (e.g., use plain language), tailoring content in psychoeducation (e.g., to learning style, to cultural worldview), and methods for facilitating a dialogue about the information (i.e., five question types), for facilitating understanding and retention of the information (e.g., tailor to individual needs, use of varied teaching modalities), and how to end psychoeducation and engage in related goal-setting, where applicable.

CONCLUSIONS

We frame psychoeducation as a collaborative approach to teaching where client engagement, understanding, and utilization of the information provided is the central goal. We offer a novel resource with pragmatic value to trainees, providers, and clinical supervisors who do not consider themselves aligned with a single evidence-based modality but who may benefit from training and proficiency assessment in core, behavioral health counseling competencies.