Juggling Multiple Roles: Staff and Client Perceptions of Keyworker Roles and the Constraints on Delivering Counselling and Support Services in Methadone Treatment

Abstract

Previous research on methadone treatment, including that investigating counselling and support services, has focused on the treatment outcome rather than process. This paper uses qualitative data highlighting the perceptions and experiences of clinic staff and clients to explore the processes involved in the delivery and receipt of counselling and support services. A typology of the perceived roles of keyworker staff is constructed and the different underlying tensions that constrain the deployment of some of these roles are discussed. For example, findings show that on an interactional level the extent to which staff can deploy the “counsellor” role is limited by client perceptions of them as the “gatekeeper” to methadone. Also, that issues beyond the interactional level, such as resource constraints, can mean that staff only have time to monitor client progress rather than deliver counselling and support roles. The implications for practice are then discussed.

Key Words:

• methadone treatment
• treatment process
• counseling
• support services