The therapeutic relationship between therapists and substance-using clients: A qualitative exploration

Abstract

Objective: To explore the experiences of therapists within their therapeutic work with drug-using clients, specifically what they found helpful and hindering.

Design: Interpretative phenomenological analysis (a qualitative methodology) was used.

Method: Eight semi-structured interviews were conducted with clinical psychologists who worked with substance-using clients.

Results: Five complex and interconnecting themes emerged from the analysis: participants spoke of the need to ‘find hope’ in their work with clients. This was helped by understanding the ‘core meanings’ of substance misuse. Participants undertook significant ‘responsibilities’ with their clients and the process of assessing the risks involved in the work was linked to a sense of ‘fear’. ‘Tolerance’ of the risks and responsibilities within the work was necessary for participants to continue therapeutic work. Therapeutic work was inextricably linked to ‘keeping connected’ to clients through establishing and maintaining a strong therapeutic relationship.

Conclusions: These themes may serve as the basis for further research. Links to the existing research literature, implications for clinical practice, and the potential for future research are discussed.

Keywords:

• Substance misuse
• therapeutic relationship
• therapist

Acknowledgements

Dr Jenny Keen, General Practitioner in Substance Misuse, for her involvement in the early stages of the design of this study. Dr David Best, University of the West of Scotland, for reading an early draft of this paper. The clinical psychologists who participated in the study.

Declaration of interest

The authors of this paper confirm that the material has not been published in any other journal. The full version of the research detailed in this article was part of the clinical thesis of Dr Gemma Kothari for the Doctorate in Clinical Psychology at the University of Sheffield. All authors have been personally and substantially involved in the work leading to the paper, and hold themselves jointly and individually responsible for its content. Relevant ethical safeguards have been met in relation to the confidentiality and consent of the patients involved in the research. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.