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Theorizing the therapeutic process in substance use-related dependency treatment
Stockholm University, Faculty of Social Sciences, Department of Social Work. Högskolan i Gävle, Sverige.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the thesis was to increase knowledge on how to understand the therapeutic process highlighting the importance of the therapeutic relationship as described by therapists and clients in substance use-related dependency treatment. The research questions were related to how the therapeutic process can contribute to a positive outcome considering the therapists’, the clients’ and close co-dependent relatives’ perspectives.

 

The thesis followed a qualitative and narrative research design and consists of six studies (I-VI). Study I contributed a description of a multidimensional interactional model for the analysis of substance use-related dependency. The study revealed how a multidimensional interactional model can provide holistic and detailed knowledge about the complex processes involved in the use or misuse of alcohol and drugs. The interactional model was illustrated by a narrative analysis of qualitative empirical data. This model seemed to support a person-by-situation interactional analysis of substance use-related dependency. Study II revealed the possibilities and limitations of using a self-theoretical perspective in the analysis of the use or misuse of alcohol and drugs. The self-theoretical perspective was related to empirical case illustrations based on qualitative or narrative data. The implications of studies I and II were that a self-theoretical perspective can be integrated within a multidimensional model and can be a fruitful theoretical framework for the analysis of treatment processes of dependency. Study III presented conceptual contributions for understanding treatment of substance use-related dependency, focusing on the importance of the therapeutic process and the therapeutic relationship and the use of narrative methods. Study IV presented a structural perspective on clients’ narrative descriptions of different phases of the use or misuse of alcohol and drugs including phases of treatment. Study V contributed an in-depth analysis of three therapists’ narratives of therapeutic relationships in the treatment of drug-dependent clients. The analysis pointed out the multidimensional aspects of the treatment and focused on three phases of therapy; starting the therapeutic process and building a therapeutic relationship, the ongoing therapeutic process, and the closing phase of therapy. The study also presented an in-depth analysis of two narrative case histories on dependency treatment. Study VI focused on a qualitative in-depth analysis based on narrative data from a group of 10 clients that had undergone treatment for alcohol and drug use or misuse. The study also included qualitative and narrative data from four co-dependent clients and six therapists about their views on the treatment process and the therapeutic relationship. The results of the study described how to understand the experiential world of the clients and their cognitive, emotional and behavioral changes associated with the treatment process.

 

The thesis’ contributions relate to an outline of a self-theoretical perspective integrated within a multidimensional interactional model for the analysis of the therapeutic process and the therapeutic relationship in substance use-related dependency treatment. The theoretical analysis sheds new light on the complexity of the treatment process and the clients’ struggle with their personal identity and sense of self, especially their drug self.

Place, publisher, year, edition, pages
Stockholm: Department of Social Work, Stockholm University , 2018. , p. 226
Series
Stockholm studies in social work, ISSN 0281-2851 ; 39
Keywords [en]
Therapeutic process, therapeutic relationship, therapeutic alliance, substance use-related dependency, treatment, self, self-theoretical perspective, self-theory, alcoholic self, drug self, sober self, mind, multi-mind, multidimensional model
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-159303ISBN: 978-91-7797-350-8 (print)ISBN: 978-91-7797-351-5 (electronic)OAI: oai:DiVA.org:su-159303DiVA, id: diva2:1243224
Public defence
2018-10-15, Aula Svea, Socialhögskolan, Sveavägen 160, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 6: Submitted.

Available from: 2018-09-20 Created: 2018-08-30 Last updated: 2018-11-21Bibliographically approved
List of papers
1. A Multidimensional Model for Narrative Analysis of Substance Use-Related Dependency
Open this publication in new window or tab >>A Multidimensional Model for Narrative Analysis of Substance Use-Related Dependency
2013 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 48, no 13, p. 1306-1316Article in journal (Refereed) Published
Abstract [en]

This chapter examines the possibilities and limitations of using a narrative method as a framework within a multidimensional model for exploring and analyzing the use and misuse of alcohol and drugs. It is posited that a multidimensional model, based on narrative reasoning, can give a more detailed and specific understanding of substance users, who represent a heterogeneous population of people, and of substance use-related dependency problems. Such a model describes and analyses the drug-use related problems in a manner that provides holistic and important information and knowledge about the person by contextual and situation interaction processes which are involved in the use/misuse of alcohol and drugs. Tentative conclusions and unresolved critical issues are considered.

Keywords
mind, multidimensional model, narrative method, narrative research, dependency, addiction, identity, self alcoholic self, drug self, sober self
National Category
Substance Abuse Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-96143 (URN)10.3109/10826084.2013.814980 (DOI)000325360400004 ()
Note

AuthorCount:3;

Available from: 2013-11-12 Created: 2013-11-11 Last updated: 2018-08-30Bibliographically approved
2. A Self-theoretical Perspective on the Use-Misuse of Alcohol and Drugs Based on Qualitative and Narrative Data
Open this publication in new window or tab >>A Self-theoretical Perspective on the Use-Misuse of Alcohol and Drugs Based on Qualitative and Narrative Data
Show others...
2013 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 48, no 13, p. 1317-1335Article in journal (Refereed) Published
Abstract [en]

This article discusses different self-theoretical perspectives of the self that are of importance in the analysis of the use and misuse of alcohol and psychoactive drugs. The self-theories considered here include cognitive, psychodynamic, transpersonal, and social constructivist perspectives. A multidimensional perspective focusing on the connection between identity structures and analyzing the use/misuse of alcohol and psychoactive drugs is presented. The article argues for a self-theoretical analysis based on narrative data in order to reach an in-depth understanding of the use and misuse of alcohol and psychoactive drugs.

Keywords
Identity, self-theoretical perspectives, use and misuse of alcohol and drugs, dependency, dependency-related problems, self-reports on alcohol abuse
National Category
Substance Abuse Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-96144 (URN)10.3109/10826084.2013.814982 (DOI)000325360400005 ()
Note

AuthorCount:5;

Available from: 2013-11-12 Created: 2013-11-11 Last updated: 2018-08-30Bibliographically approved
3. Perspectives on Treatment, Alliance and Narratives Concerning Substance Use-Related Dependency
Open this publication in new window or tab >>Perspectives on Treatment, Alliance and Narratives Concerning Substance Use-Related Dependency
2013 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 48, no 13, p. 1386-1403Article in journal (Refereed) Published
Abstract [en]

This article considers different perspectives on the treatment of substance use-related dependency, focusing on the importance of a therapeutic relationship, working alliance, counseling, and the use of narrative methods. The article also discusses some unresolved critical issues concerning the possibilities and limitations of acquiring necessary knowledge about substance use-related dependency when using narrative research methods. The main conclusion is that the therapeutic relationship between the therapist and the client is of crucial importance for a positive outcome of treatment and that narrative methods provide a detailed empirical database for analyses of substance use-related dependency.

Keywords
therapeutic relationship, therapeutic alliance, narrative, substance use-related dependency treatment
National Category
Substance Abuse Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-96145 (URN)10.3109/10826084.2013.815000 (DOI)000325360400011 ()
Note

AuthorCount:3;

Available from: 2013-11-12 Created: 2013-11-11 Last updated: 2018-08-30Bibliographically approved
4. Narratives of Clients' Experiences of Drug Use and Treatment of Substance Use-Related Dependency
Open this publication in new window or tab >>Narratives of Clients' Experiences of Drug Use and Treatment of Substance Use-Related Dependency
2013 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 48, no 13, p. 1404-1415Article in journal (Refereed) Published
Abstract [en]

The article focuses on narratives of clients' experiences of using/misusing alcohol and drugs and includes comments on their therapeutic process during treatment for dependency on psychoactive drugs. It discusses the role of narratives that focus on clients' experiences of understanding the use/ misuse of psychoactive drugs, emphasizing the importance of the narratives. Narrative therapy for substance-use-related dependency is discussed. Insight into the treatment processes of dependency, based on narrative case illustrations, is also provided.

Keywords
alliance, therapeutic alliance, narrative, dependency, treatment, therapeutic processes, narrative therapy
National Category
Substance Abuse Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-96146 (URN)10.3109/10826084.2013.817148 (DOI)000325360400012 ()
Note

AuthorCount:3;

Available from: 2013-11-12 Created: 2013-11-11 Last updated: 2018-08-30Bibliographically approved
5. Therapists' Narratives of Therapeutic Relationships in the Treatment of Drug-Dependent Patients
Open this publication in new window or tab >>Therapists' Narratives of Therapeutic Relationships in the Treatment of Drug-Dependent Patients
2013 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 48, no 13, p. 1416-1433Article in journal (Refereed) Published
Abstract [en]

The article explores and analyzes therapists' narratives, using selected stories, and their strategies for achieving a positive therapeutic relationship and a therapeutic alliance with their patients as a critical dimension to enable effective treatment with patients manifesting dependency problems. Although the therapists are applying different treatment and dependency theories and methods they all emphasize the importance of the therapeutic alliance in order to be successful in the treatment process.

Keywords
Therapeutic relationship, therapeutic alliance, narrative, dependency, treatment, the actor-spectator paradox
National Category
Substance Abuse Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-96147 (URN)10.3109/10826084.2013.815017 (DOI)000325360400013 ()
Note

AuthorCount:1;

Available from: 2013-11-12 Created: 2013-11-11 Last updated: 2018-09-20Bibliographically approved
6. Theorizing therapists’, clients’ and co-dependent relatives’ narratives of the therapeutic process in substance use-related dependency treatment
Open this publication in new window or tab >>Theorizing therapists’, clients’ and co-dependent relatives’ narratives of the therapeutic process in substance use-related dependency treatment
(English)In: Article in journal (Refereed) Submitted
Abstract [en]

This study focuses on therapists’ and clients’ qualitative and narrative descriptions of how they experience the therapeutic process, including the therapeutic relationship, in substance use-related dependency treatment. The aim of the study was to increase knowledge on how to understand the treatment process, and highlighting the importance of the therapeutic relationship applied to substance use-related dependency treatment. The empirical study focuses on an in-depth analysis based mainly on qualitative and narrative data considering 10 clients, six therapists and four co-dependent relatives from a dependency treatment unit localized in a mid-sized town in Sweden. Clients who participated in the study had undergone treatment for alcohol and drug use/misuse or co-dependency problems that resulted in positive outcomes. The therapists included in the study were working at the same treatment center. The empirical results give a detailed picture of the experiential world of the clients and their cognitive, emotional and behavioral changes associated with the treatment process and how they viewed the meaning of the therapeutic relationship in the treatment process. The results also include the therapists’ point of view of the treatment process, including their opinion of the meaning of the therapeutic relationship and how they describe the treatment process related to “what works” in therapy. The results describe the complexity and importance of the therapeutic relationship in a substance use-related dependency treatment process. The results reveal that the treatment process follows a dynamic pattern in which changes of the clients’ sense of self, cognitions, emotions, self-knowledge and self-empowerment play a central role. The interviews described some divergent perspectives between therapists and clients concerning the interpretation of the therapeutic process. However, there were also similarities between the clients’ and the therapists’ narrative accounts regarding the importance of clients’ mentalization and self-realization processes, including the importance of finding their “true self” and coping with their inner struggle between “the drug self” and “the sober self “ and reaching a more sustainable self-system.

Keywords
Substance use-related dependency treatment, treatment process, therapeutic relationship, treatment of alcohol and drug dependency, self-theoretical perspective, and multidimensional interactional analysis
National Category
Social Work Substance Abuse
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-159427 (URN)
Available from: 2018-08-29 Created: 2018-08-29 Last updated: 2018-09-04Bibliographically approved

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