A Qualitative Exploration of Engagement Among Rural Women Entering Substance User Treatment

Abstract

A semistructured interview was administered to a purposive sample of 12 rural women early in substance misuser treatment in a gender specific, intensive outpatient treatment program from March 2001 through March 2003. The interview used open-ended questions about the women's state of mind before entering treatment, the experiences that helped them feel more comfortable with treatment, the experiences that caused them some discomfort in treatment, and any changes they would recommend to the program content or process in an attempt to gain understanding about factors that might facilitate a subjective comfort and engagement with the treatment experience. In approaching treatment, the women almost uniformly expressed a mixture of anxiety about the requirements of treatment and cynicism about its effectiveness. Although aware of the content and structure of the treatment program, the women focused on interpersonal experiences as the critical factors in their level of comfort once in treatment. The most frequently mentioned factors adding to comfort with the treatment experience were the welcoming, accepting, and non-judgmental attitudes of the staff; having their perceptions of their problems taken seriously by the treatment staff; being with other women who shared much of their experiences; and a respectful and generally positive attitude on the part of both the staff and the patients. The only factor that consistently caused some of the women discomfort in treatment was a difficulty in trusting that some of the other women in treatment would keep the matters discussed in group sessions confidential. The women were not completely satisfied with the program content and structure, but this seemed of very little importance to them in relation to their experience of comfort with their treatment experience.

Keywords:

• client engagement
• women's treatment
• gender specific treatment
• substance misuse
• therapeutic alliance
• rural treatment
• women's issues
• client retention
• empathy
• depression
• anxiety
• domestic violence

Notes

²There are those who maintain that the complexity of such behaviors cannot be captured in what is essentially a linear model and that the use of linear analysis might lead to misleading conclusions. (Buscema, 1998).

³Services consisted of outpatient individual and group therapy, psychoeducational group sessions, parent education, and family therapy sessions.

⁴Nvivo is a qualitative data analysis program that allows researchers to index text into inductive categories and then further identify and index subthemes within those categories. It can also provide a count of text units that participants devote to a specific theme or subtheme, giving a rough indication of the possible relative importance of them.

⁵Treatment site's psychosocial dimensions–environmental “atmosphere” are rarely noted as actual/potential facilitators or barriers for therapeutic engagement of substance users in the literature. Such dimensions include, among others, a relationship dimension, personal development dimension, maintenance and change dimension, emotional catalyzer dimension, information catalyzer/processing dimension, environmental perceptions, attitudes and values dimension, problem-solving/adaptational dimension, and dimension–boundary definer (Tuan 1974).

⁶GED is a means of earning the equivalent of graduation from high school without actually having to return to the classroom, for adults who have not completed the formal course of study earlier.

¹Treatment can be briefly and usefully defined as a planned, goal-directed change process, which is bound (through culture, place, time, and the like) and categorized into professional-based, tradition-based, mutual help–based (like AA and NA), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever type—which aren't also used with nonsubstance users. Editor's note.