|
The fundamental concern of the therapy approach used in our practice, is the need to develop and employ an empathic style and a sound therapeutic alliance built on trust, which gives pre-eminence to a collaborative approach avoiding a directive or prescriptive style and which minimises resistance. Used within the context of a planned therapeutic program, it can also have the effect of changing expectations about outcomes and could be linked to an increased sense of self-efficacy. The program emphasises the empathic alliance and the principles associated with motivational interviewing as explicated by Millar and Rollnick (1997). As such it does not comply with the principles underlying Cognitive Behavioural Therapy, although CBT strategies are used throughout the treatment phase of the program. The therapists should take a ‘non-expert' position and are non-directive or presume to know what is right for the client. We also believe that psychological and behavioural problems, including drug dependency are motivated by emotional factors, not cognitions. Direct challenges to the person's integrity or choice is thought to create resistances and impede the therapeutic process. In the next phase the therapist allows the client to learn a new way of relating within the therapeutic frame. This allows the client to develop a new awareness of how to safely have needs met and to reduce levels of anxiety by being better able o predict responses from the environment. Changing subjective feeling states is the primary goal of therapy so that clients feel better about themselves and therefore act differently in the world. A treatment program dealing with drug addiction needs to be based on an understanding of how pharmacotherapy works in conjunction with psychological interventions and then we need to build a structure to maximise its potential. For example, Naltrexone, when used with Cognitive Behaviour Therapy (CBT) (incorporating cue exposure), promises to produce much better outcomes than have been achieved without CBT, or when the therapy is used alone. Incorporated into this approach to drug addiction is the application of behavioural theories of conditioned responses and extinction to explain why people report reduced ‘craving'. It also explains why those who end treatment after a period of abstinence, especially coming from long-term therapeutic communities or from extended trips way from their usual environment or from jail, tend to relapse when they return to their social environment. Treatment based on cue exposure and classical and operant conditioning theory, combined with the development of an empathic and enhanced motivational style, is now possible with the use of the opiate antagonist (Naltrexone) and is contrary to earlier relapse prevention models which had as their corner-stone identification and then avoidance of triggers or cues (conditioned stimuli) and which tended to be directive and disempowering. The therapeutic components of the program are designed to:
|