EFTC 2009: Eyes on the futurereview of the conference

Anne Goossensen

Researcher at Erasmus Universiteit (Health Policy and Management) & Professor Substance Abuse Treatment INHolland (Practice) University.

Opening: participation of 27 countries

Content of the congress

Overwhealming amount of information:

Meetings at welcome reception

8 Plenaries with 16 lectures

51 workshops in 5 themes

3 site visits with different treatment programmes each

3 Films

Meetings at Gala dinner

And different satellite activities, like physicians meeting

Focus of the review

Leading Questions / issue:

Eyes on the future. Who’s future? Of the TC’s? Of the professionals?

Of the patients? (Teeuwisse)

1. Effectiveness issue

2. Policy issue

3. Innovation issue

4. Therapy methods issue

5. Special populations issue

6. Spirituality issue

1. Effectiveness issue / right of existence

Cochrane Collaboration shows little effectiveness

De Leon presents evidence from other types of research

For many psycho-social elements in TC’s there is evidence (like

reïnforcement, peer mentoring en role modeling)

An RCT just not fits on a TC

Not being able to measure is something else than not effective

It is clear that the EBM research paradigm fits not to TC’s

Other evaluation studies are possible, and should be done more

Evaluation of the method (WHAT people do)

Namely HOW they do it

That points to the relationship as a critical succes factor

That should be included in an evaluation frame

What causes effect in psychotherapy?

15%

40%

40%

15%Relationship

Used methods

Factors outside therapy

1. Effectiveness issue / right of existence

This was a main issue through the conference

If TC’s want to continue existing an ANSWER is necessary

To evidence based financing structures

2. Policy issue

As a movement: are we connected, disconnected or unknown (Turner)?

Not connected to important organizations

A critical succes factor for the future

At European level, but also national and regional

Very strong regional networks / care chains, where TC’s are imbedded

in – a strong point

Clear description of the goal population helps matching regional patient

to treatment

Furthermore there seem to be different languages between the TC

movement and other parties, here bridges can and have to be built

3.Innovation issue

How can TC’s innovate & grow?

Community as a method – the basic idea

Standards / manualized / therapeutic integrity

Fidelity to the model

Checking by audit through other TC members

For me this is again only the WHAT part of the story

Thinking of two brain hemispheres

One side: mental, logical reasonable, manuals, protocols and models

The other side: emotions, creativity, intuition, relating, ‘warmth’

Innovations should affect both sides: logic and love

Let’s try to avoid focus only on the mental/logical side

4. Therapy issue

Encounter groups

Running Therapy

Multidimensional Family Therapy

Self-help

Bonding Therapy

Aftercare and Rehabilitation

Movement Therapy

Wilderness Therapy

Reflecting Art Therapy

Motivation methods

Schema Focus Therapy

Website focussed on learning (Digital Community)

5. Special populations issue?

TC and Justice - Culture clashes

Making a whole prison a TC!

About dual diagnosis in general

About ADHD

About youngsters

Integrate knowledge on new subgroups

In existing model

Keep up with new information

6. Spirituality issue

My psychology thesis was about addiction care and spirituality

What is meant with spirituality?

12 steps and the higher power?

Giving meaning?

Definition of Eric Broeckaert?

Unique relationships, ecologicaly and systemic interconnected?

Interiorization of life events & experiencing a new life style?

Mindfulness?

Eyes on the future: being present in relationships!

The TC is an unique setting in terms of:

Forming deep and healing relationships

Ability to work through trauma and attachment difficulties

And thereby change lives, change identities of persons

Enable turning points in (family) histories of addiction

Spirituality can help to realize and optimize this power of relationships in

the TC

For instance by mindfulness, the power of attention, becoming

present for professionals and patients

Professionals can improve in relating by practising mindfulness,

becoming at ease in the here and now

Eyes on the future: being present in relationships!

Innovation can happen by:

Performing (effect) research also from a relation focused

perspective

Educating professionals in quality of relationship building and

communication

There are concepts and validated research instruments available

Combine fidelity work with relation improvement work

Perform bonding groups

Teaching mindfulness to staff and patients

Eyes on the future: being present in relationships!

Disconnectedness at policy level may be repaired by:

Communicate about relation based work as identity of TC’s

Educate parties about the deeper healing options

Describe and communicatie which patients groups fit to a TC

Make TC’s part of the care chain

Show results from relation based research besides EBM

Eyes on the future: becoming present in relationships!

In short:

Nowadays professionals will not have the changing experiences of

those who initiated the TC’s

But new generations can aim at the same attainments with new

concepts

Relationship building is such a concept, as an offer to let patients heal

themselves while relating to the community

Mindfulness (being present) is such a new and powerful concept that

enables professionals nowadays to ‘be’ a TC and not just ‘run it’ (De

Leon)

Thank you for your attention!

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