Aymeric Reyre1, Raphaël Jeannin2, Myriam Largueche3, Marie Rose Moro4, Thierry Baubet5, Olivier Taieb6. 1. APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France; Ile-de-France Regional Center for Bioethics, 1 rue Claude Vellefaux, 75010, Paris, France. Electronic address: aymeric.reyre@aphp.fr. 2. APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France. Electronic address: raphael.jeannin@aphp.fr. 3. Roger Prévot Psychiatric Hospital, Department of Psychiatry, 5 avenue du Docteur Fleming, 92600, Asnières sur Seine, France. Electronic address: myriamlargueche@gmail.com. 4. CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France; APHP-Cochin University Hospital, Department of Psychiatry, Paris 5 SPC University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: marie-rose.moro@aphp.fr. 5. APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France. Electronic address: thierry.baubet@aphp.fr. 6. APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France. Electronic address: olivier.taieb@aphp.fr.
Abstract
BACKGROUND AND AIMS: A good therapeutic alliance plays a major role in the healing process. Professionals working in addiction treatment report high levels of psychological distress related to work and this may challenge the establishment of a trustful therapeutic alliance, and lead to a loss of care quality provided to service users. The purpose of this study was to investigate the experience of specialized professionals, its effects on trust and the therapeutic alliance, and the means to restore them. DESIGN: We conducted a qualitative study using a semi-structured questionnaire and a narrative tool. Discourse was extracted from focus groups and individual interviews and analyzed following the Interpretative Phenomenological Analysis method. PARTICIPANTS: Twenty-six professionals from three addiction treatment centers in the Paris area were interviewed. FINDINGS: The difficulties weighing on the care alliance were described by the participants in terms of their nature, their effects and means to overcome them. Emotional drain leads to a climate of relational distrust and the temptation to desert or over-control patients. Teambuilding, specific training and self-care are viewed as means to restore a therapeutic alliance based on an appropriate type of trust. CONCLUSIONS: Distrust deriving from professionals' challenging experiences may lead to worrying consequences. Promoting democratic organization of care structures, specific training, and also responsible self-care on the part of professionals could help to restore a type of trust that helps to establish a therapeutic alliance suited to service user individualities. This could ultimately be beneficial for user care, professional wellbeing and team functioning.
BACKGROUND AND AIMS: A good therapeutic alliance plays a major role in the healing process. Professionals working in addiction treatment report high levels of psychological distress related to work and this may challenge the establishment of a trustful therapeutic alliance, and lead to a loss of care quality provided to service users. The purpose of this study was to investigate the experience of specialized professionals, its effects on trust and the therapeutic alliance, and the means to restore them. DESIGN: We conducted a qualitative study using a semi-structured questionnaire and a narrative tool. Discourse was extracted from focus groups and individual interviews and analyzed following the Interpretative Phenomenological Analysis method. PARTICIPANTS: Twenty-six professionals from three addiction treatment centers in the Paris area were interviewed. FINDINGS: The difficulties weighing on the care alliance were described by the participants in terms of their nature, their effects and means to overcome them. Emotional drain leads to a climate of relational distrust and the temptation to desert or over-control patients. Teambuilding, specific training and self-care are viewed as means to restore a therapeutic alliance based on an appropriate type of trust. CONCLUSIONS: Distrust deriving from professionals' challenging experiences may lead to worrying consequences. Promoting democratic organization of care structures, specific training, and also responsible self-care on the part of professionals could help to restore a type of trust that helps to establish a therapeutic alliance suited to service user individualities. This could ultimately be beneficial for user care, professional wellbeing and team functioning.
Authors: Delia Motavalli; Jessica L Taylor; Ellen Childs; Pablo K Valente; Peter Salhaney; Jennifer Olson; Dea L Biancarelli; Alberto Edeza; Joel J Earlywine; Brandon D L Marshall; Mari-Lynn Drainoni; Matthew J Mimiaga; Katie B Biello; Angela R Bazzi Journal: J Gen Intern Med Date: 2020-09-11 Impact factor: 5.128
Authors: Justin S Tauscher; Eliza B Cohn; Tascha R Johnson; Kaylie D Diteman; Richard K Ries; David C Atkins; Kevin A Hallgren Journal: Addict Sci Clin Pract Date: 2021-06-15