Pessimistic therapists

DJ Mac has a new post on therapeutic pessimism:

However it may have been what Gossop calls the ‘Clinical Fallacy’. This is the phenomenon whereby people moving on to abstinent recovery move out of drug treatment services. Workers don’t get to see visible recovery – instead they get to see people who have deeper problems, who relapse or fail to move on. This reinforces the belief that people don’t recover from addiction.

My gloomy colleague is not on her own in this regard. When David Best asked Welsh addiction workers how many of their clients they thought would eventually recover, they estimated 7%.

The source interview of David Best by Bill White expands on Best’s views:

We also still cling to a model that is about pathology management, which has two implications, the first being that we don’t focus enough on strengths and the second that we reinforce a model that sees addiction (and recovery) as incorporated rather than as being socially mediated and managed.

I think we miss two things that matter. One is the basic human contact and relationships that surround addiction treatment therapies, and the second is the effects treatment can exert on people’s social networks and daily activities. It seems to me that the real outcome measures of value are the social networks people are embedded in, the degree of commitment to these social networks, and the things that fill their daily lives.

The interesting issue for me is much less about what particular therapies and modalities we offer and more about whether we can inspire belief that recovery is possible, establish a partnership between the client and the worker to facilitate that change, mobilize recovery supports within the client’s natural environment, and link the client to those community resources. We also need to locate recovery within a developmental perspective that recognizes the lengthy (and non-linear) journey that most people experience in recovery. This means there are plenty of opportunities for a diverse array of interventions and also that people will evolve in their needs and their resources as the recovery journey progresses.