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Good rapport, good results in drug counseling. (Enhance Counselor's Skills).

Patients who achieve better rapport with their counselors are likely to have a better outcome with drug abuse treatment than those who do not, reported George W. Joe, Ed.D., and his colleagues at Texas Christian University in Fort Worth.

An analysis of two cohorts, including 577 patients admitted for outpatient methadone treatment, revealed statistically significant correlations between counseling rapport and positive treatment outcomes 1 year or 18 months posttreatment.

On follow-up, patients who had poor rapport with their counselors were more likely to have opiate- and cocaine-positive urine tests, to self-report weekly use of heroin or cocaine, to have engaged in illegal activity, and to have been arrested (Psychiatr. Serv. 52[9]: 1223-29, 2001).

The two cohorts differed in many respects. Cohort 1 consisted of 354 patients admitted to three nonprofit, community-based, outpatient methadone treatment programs between 1990 and 1993. Cohort 2 consisted of 223 patients who were admitted to a single, private, for-profit, outpatient methadone treatment clinic between 1995 and 1997. Compared with cohort 2 patients, cohort 1 patients were significantly younger, more likely to be white, more likely to be married or living as married, more likely to have a job, and less likely to have had involvement with the criminal justice system. The groups also differed in retention rates, with 38% of cohort 1 and 60% of cohort 2 staying in the treatment program for a full year.

That both cohorts exhibited similar relationships between counseling rapport and treatment outcome support[s] counseling rapport as an important component of the treatment process for drug abuse," they said. "These findings support the use of interventions to increase patient readiness for treatment and to enhance the counselor's skills ... as a means of improving counseling rapport.

Rapport was assessed using questionnaires completed by counselors at months 1, 2, 3, 6, 9, and 12 of treatment. (Patient responses to questionnaires on rapport were found to be highly skewed toward the upper end of the rapport scale.) Counselors were asked to rate items such as "easy to talk to," "warm and caring," "honest and sincere," "understanding," and "not in denial about problems" on a five-point (cohort 1) or a seven-point (cohort 2) scale.

A logistic regression analysis demonstrated that counseling rapport was a more significant predictor of poor outcome than either treatment retention, treatment satisfaction, or treatment status.
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Author:Finn, Robert
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Feb 1, 2002
Words:387
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