Yesterday’s post on addiction counseling as community organization got me thinking about something I’d heard from a Scott Miller presentation.
Miller argued that treatment outcomes are due to the following factors in the following proportions:
- 40%: client and extratherapeutic factors (such as ego strength, social support, etc.)
- 30%: therapeutic relationship (such as empathy, warmth, and encouragement of risk-taking)
- 15%: expectancy and placebo effects
- 15%: techniques unique to specific therapies
Part of his argument was that we can’t control that 40% related to client and external factors, and we spend tons of time and capital arguing about the 15% related to specific therapies. He argues that we should spend much more time on the 45% we have more control over, hope and the alliance.
Here’s what I was thinking—that recovery management attends to that 45% plus the 40% Miller says is out of our hands. Bill White calls on us to shape those external factors. The attention to family, community, social, vocational, educational and other factors extends our reach.
Its worth noting that Physician Health Programs do this too, by creating social peer support (caduceus groups) and support within the workplace.