11 Mar / From the Therapeutic Alliance to the Evaluation of Treatment Outcomes Expectations
The Therapeutic Alliance
The therapeutic alliance may be one of the central factors in the context of addiction treatment in a Therapeutic Community. And, above all, it can also be understood as an agent of change.
This concept has been the subject of multiple studies. Edward S. Bordin, for example, was one of the theorists who extensively studied the concept. Bordin says that regardless of the methodological paradigm of intervention, the therapeutic alliance presupposes three main elements.
> First, the agreement (implicit or explicit).
> Secondly, the emotional link and agreement on the tasks that will enable change.
> Finally, treatment success can become conditioned if one of these elements fails.
The Therapeutic Contract and the Individualized Addiction Treatment Plan
At Dianova, and with respect to the agreement, the Client signs the Therapeutic Contract at the time of its admission. This defines the terms in which its treatment will take place. Indeed, this moment, symbolic but very important, occurs between the client and the monitor who receives him/her. And it reinforces, from the first moment, the adhesion to a process of significant change.
As far as the emotional link is concerned, the therapeutic alliance as a working relationship with our clients develops in a logic of proximity. Optimal proximity, the proximity that allows the therapeutic monitor to be close enough to the client. This produces a wave of empathy, comfort and warmth without losing “visual acuity” and objectivity. That is, without going beyond the boundaries of the therapeutic relationship.
To that extent, we believe that the theoretical models, techniques and activities are at the base of our drug addiction and alcoholism treatment programs. But what serves as a catalyst for change is the relationship, the bond that builds and develops along the same. It is, above all, more than a helping relationship. It is a relationship that should help to give our clients the confidence they need to become functional and independent.
Cognitive-behavioural therapy in the addiction treatment at Dianova in Portugal
We believe that it is in the space of this relationship that the beginning of a new thinking, a new perception emerges. Through a cognitive-behavioural approach, we develop a diversity of activities. In this way, they allow to evaluate, by comparison, the consequences of the behaviours of the individual and in what way they are maintained or not.
We encourage a strong investment in everyday pedagogy, for example, participation in occupational activities, responsibility for everyday tasks, healthy leisure management. In this sense, the client can perceive the changes that have occurred. On the other hand, in a recursive logic, it accedes to new levels of change and processes new information that will give rise to new behaviours. These will benefit both the individual himself and the people around him/her.
At this level it is also important to mention the figure of the Therapeutic Monitor. Its fruitful intervention promotes on the clients two fundamental aspects. On the one hand, the development of the daily activities at the Rehab Centre. On the other hand, it offers the possibility to them, through a close relationship, to see their commitment, motivation, skills recognized and validated. This figure appears for many users, as the reference figure that offers the insertion of new values and the contact with a secure link.
Another factor that facilitates the understanding of the clients of their evolutionary path is evaluation. Throughout its treatment program the multidisciplinary team of Dianova carries out a three-level evaluation.
> Hetero-evaluation (peer evaluation).
> Evaluation by the Multidisciplinary Team.
The information gathered in these three moments is then organized by the different parameters. In particular:
> Physical state.
> Psychological state.
> Integration in the Community Dynamics / Assumptions of Standards in a first phase phase-in evaluation for the second phase of the program.
> Consolidation of the Rupture with Consumption Decision.
> Commitment / Responsibility.
> Labour and Social Skills.
> Family / Interpersonal Relations in later evaluations.
The Individual Treatment Plan and New Project of Life
Then, through the presentation of specific objectives, it is communicated what constitutes the Individual Treatment Plan. The individualization of the treatment program makes it more flexible and adapted and thus guarantees the focus on the fulfilment of the aspirations, well-being and personal fulfilment of our clients.
The “arrival” of our clients to the design of their project of life, that is, at the moment of their social reintegration is for many a moment that generates anguish, uncertainty and some fear. In this way, allied to the competences and resources of each individual is, as predictive factor of success, a strong therapeutic alliance that was constructed throughout the treatment.
My experience leads me to say that, often, what exists in the treatment is the space of relationship that allows the emergence of new narratives and the construction of new meanings.
Dr. Rafaela Oliveira, Therapeutic Monitor – Social Worker, Therapeutic Community Quinta das Lapas Dianova.
March 10, 2019