Addicts and alcoholics who come into treatment are often scared about getting clean and sober, they bring with them beliefs and expectations that need to be comprehensively considered and addressed by the therapist. If they are not addressed the entire therapeutic process is at risk of being derailed.

In the series 20 things you should know about rehabilitative treatment: What works. This list was compiled by the European Association for the Treatment of Addiction, according to the latest evidence.

For rehab to work, different therapy approaches should be used for different kinds of patients, and should relate to the stage the addict or alcoholic is in their substance use and recovery process. A range of services should be provided to meet the individual patient’s unique needs.

But the most important way to make addiction therapy a success is to consider and address a client’s beliefs and expectations about treatment and overcoming their addiction.

There are many beliefs and expectations held by any given client that, if left unaddressed, could lead to unsuccessful and incomplete treatment.

For example, many patients come into rehab or attend therapy with the belief that “it is a sign of weakness or incompetence to be in treatment”. But therapists can build a productive therapeutic relationship with clients by “noting that it takes courage and hard work to participate fully in therapy”. This addresses and helps to dismantle the shame often felt by addicts and alcoholics on entering treatment and admitting that they are not able to get sober by themselves without help. This approach also establishes “the baseline notion that therapy will be difficult, the chance that a patient will bail out of treatment at the first sign of discomfort”.

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Rehab works best when therapy addresses a patient’s beliefs and expectations

Explaining that the pain experienced by the patient is like that of receiving treatment for a bodily medical ailment like a broken bone can help to allow the patient to understand that the pain is a necessary part of the healing process.

Treatment often involves the discussion of emotionally painful issues and this approach manages a commonly-held expectation from clients that the treatment process “should always feel good”.

Another dysfunctional belief held by many clients is that the therapist will be unable to help because he/she simply does not “understand” the client’s situation and helplessness when it comes to getting clean and sober. A counsellor can address this belief by thoroughly considering the answers to questions posed to the client such as:

What are your thoughts about coming to meet with me today?
I’m not sure whether you feel good or bad about seeing me, and I’m not sure what your expectations or hopes about treatment are. But I would like to know – are you willing to share your thoughts with me?
What are your impressions about how things went in today’s session?
Was there anything that I said that you didn’t like or agree with?
Was there anything about today’s session that was particularly helpful?
What should we make sure we continue to talk about in our next session in order to get the most out of being here?

This genuine consideration of the beliefs and expectations of the patient regarding therapy will only work to enhance the usefulness of therapy – allowing the counsellor to adapt their approach and respond to the client appropriately.

It is always better to meet the patient where they are at and deliver therapy that the client perceives as useful and helpful.

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