Interaction of Counseling Rapport and Topics Discussed in Sessions with Methadone Treatment Clients

Abstract

Therapeutic rapport between counselors and clients in drug user treatment has been shown to be an important predictor of follow-up outcomes. This naturalistic study investigated the relationship of counseling rapport to drug-related topics discussed in counseling sessions in a sample of 330 clients and nine counselors. These voluntary clients had been admitted to a private, for-profit outpatient methadone treatment in Texas between September 1995 and August 1997 and received no-fee services for a year for participation in this study. The data were gathered using forms in the TCU community treatment assessments (www.ibr.tcu.edu) that measured intake information, counseling session topics, and counselor evaluation of the client. A majority were males, Hispanic, had a pending legal status and the average age was 39. Co-occurring drug dependence for these heroin users included cocaine (38%) and alcohol (31%). The results supported the hypothesis that higher rapport would be associated with addressing clients in a more “supportive approach” that emphasized relapse prevention and strengths-building while lower rapport would be associated with a punitive counseling style that stressed program rules and compliance. The influences of client background, counselor differences, and during-treatment positive urines were also examined. Although counselors differed in their general manner of dealing with clients, each also showed flexibility determined in part by client behavior (such as continued cocaine use). The findings indicate that focusing on constructive solutions is the preferred counseling approach.

Keywords:

• contingency management
• program compliance
• relapse prevention
• therapeutic alliance
• therapeutic rapport
• treatment compliance
• treatment effectiveness

Notes

¹Treatment can be briefly and usefully defined as a planned, goal directed change process, which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types—that aren't also used with non-substance users. In the West, with the relatively new treatment ideologies of “harm reduction” and Quality of Life (QoL) there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven treatment models. Editor's note.