Informal discussions in substance abuse treatment sessions

Abstract

This study evaluated the extent to which counselors initiated informal discussions (i.e., general discussions and self-disclosures about matters unrelated to treatment) with their clients during treatment sessions within two National Institute on Drug Abuse Clinical Trial Network protocols involving adaptations of motivational interviewing (MI). Sixty counselors across the two protocols had 736 sessions independently rated for counselor treatment fidelity and the occurrence of informal discussions. The results showed that 88% of the counselors initiated informal discussions in their sessions and that the majority of these discussions involved counselors sharing personal information or experiences they had in common with their clients. The major finding was that counselor training in MI was associated with significantly less informal discussion across sessions. A higher frequency of informal discussion was related to less counselor MI proficiency and less in-session change in client motivation, though unrelated to client program retention and substance use outcomes. The findings suggest that while some informal discussion may help build an alliance between counselors and clients, too much of it may hinder counselors' proficient implementation of MI treatment strategies and the clients' motivational enhancement process.

Informal discussions in substance abuse treatment sessions with Spanish-speaking clients

“…This study replicates and extends Martino and colleagues’ (2009) findings regarding differences in levels of ‘chat’ between counselors delivering standard treatment and those trained to perform MET in a randomized clinical trial. As in the English trials, when MET was used with monolingual Spanish speaking Hispanic clients, data from the current study suggested 1) across treatment conditions, most counselors initiated ‘chat’ in at least one of their sessions; 2) counselors trained and assigned to implement MET talked informally significantly less often than counselors in the CAU condition; and 3) higher rates of informal discussion were associated with less adherence and competence to fundamental and advanced MET strategies, more frequent use of MET inconsistent strategies, lower ratings of counselor skillfulness, less ability to maintain session structure, and less in-session increases in clients’ motivation to stop or reduce substance use.…”

“…Although some researchers have found that informal discussion involving self-disclosure may help strengthen emotional bonds and therapeutic alliance (Goldfried, Burckell, & Eubanks-Carter, 2003; Hill & Knox, 2001) and establish an egalitarian relationship which empowers clients to change (Simi & Mahalik, 1997), other researchers have found results similar to those reported by Martino and colleagues (2009). This research highlights the potential negative effects of informal discussion when counselors share personal information with their clients that is not directly related to treatment.…”

“…An interesting caveat to these integrity findings within the English MET protocol was that CAU counselors talked more often with their clients about issues that were unrelated to the clients’ treatment needs and this higher frequency of informal discussion (i.e., ‘chat’) was significantly related to less counselor MET adherence and competence and less in-session change in client motivation, though unrelated to client program retention and substance use outcomes (Martino, Ball, Nich, Frankforter, & Carroll, 2009). The findings suggested that too much informal discussion in sessions may have hindered the counselors’ proficient implementation of MET and the clients’ motivational enhancement process and that formal training in MET may have suppressed the tendency of counselors to talk informally in sessions (Martino et al, 2009). …”

“…To the extent that informal discussion acts as a culturally facilitative condition, Hispanic counselors or counselors acculturated to Hispanic customs might talk more informally with their Hispanic clients and support the broader motivational enhancement process used in MET. Alternatively, if informal interaction compromises relationship building in early treatment sessions with Hispanic clients, too much of it may hinder the counselors’ proficient implementation of MET treatment strategies and careful training in MET might be needed to reduce the extent to which counselors talk informally, as occurred in the English MET trial (Martino et al, 2009). …”

Substance use treatment barriers for patients with frequent hospital admissions

“…Although there is a limited literature addressing the attitudes and practices of providers about SU screening (Martinez & Burt, 2006;Martino, Ball, Nich, Frankforter, & Carroll, 2009;Sommers & Cohen, n.d.), few cross-sectional or prospective studies have studied the attitudes and priorities of frequent users of hospital services and their providers, and fewer still have focused on the role of SU among these patients and how SU might relate to frequent hospital admissions. In addition, traditional quantitative studies do not provide the detailed and nuanced data necessary to define interventions in this population.…”