Final Report Summary - INTERACT (Interactions in Community Treatment) 1. Background. The goal of “INTERACT” was to study communication between service providers and clients within programmes for the clinical treatment of drug misuse—these programmes, which are commonly long-term and residential, are called Therapeutic Communities (TCs). The project focussed on communication that promotes client participation and engagement in the therapeutic process. Helping clients overcome drug addiction is never a straightforward process; the therapeutic journey is constantly punctuated by communication obstacles and by practical dilemmas. The project mapped out these obstacles and dilemmas, and identified communication practices that TC members—staff and clients—use to overcome them. ‘Communication practices’ are defined here as ways of using talk to achieve specific outcomes in face-to-face interpersonal interaction. This document summarises the results of the study and explains its impact in terms of understandings on how to best support vulnerable persons. 2. Approach. I carried out the work by collecting and analysing video-recordings of group meetings between the staff and the clients of four different TCs in Italy. The corpus consisted of 36 recorded meetings (lasting approx. 1 hour each), resulting in hundreds of pages of transcripts and thousands of spoken turns. I analysed these data using a naturalist approach called conversation analysis. This involves closed examination of the ways in which people talk with each other; how they use words and several other aspects of communication (such as prosody, silences, and non-verbal behaviours including gaze and gesture) to accomplish activities, such as asking questions, giving advice, showing empathy, and many others. Each action can be realised in many different ways. I have studied the different ways in which TC members go about realising specific activities and solving particular communication problems that arise in their daily interactions; some of these ways are more effective than others in achieving therapeutic goals and promoting positive relationships amongst members. 3. Results. The project produced results in four areas of therapeutic communication: experience sharing; behaviour change; perspective change; and conflict. 3.1. Experience sharing. Sharing personal experiences is an essential part of therapeutic communication. In therapeutic group meetings, clients talk about recent events in which they have been involved, and the feelings associated with them. However, this does not always happen without difficulties. In several situations, clients can be unable or reluctant to share personal information. The study showed that, in TCs, it is important for the staff that clients share their experiences—partly to help the staff oversee the clients’ compliance to TC rules and agreed upon goals. There are cases, within the group meetings, where the staff invite a client to share and the client shows reluctance to do so, or provides incomplete or contradictory information. In these cases, the staff face a dilemma: how can they encourage the client to share without compromising the relationship with her/him? I identified a practice that TC staff use in these cases, which I termed a knowledge display (KD). With a KD the staff show that they already have some previous knowledge about a client’s experience or circumstance. By voicing this knowledge, TC staff members show their clients a direction that they can take to expand their personal reports. At the same time, TC staff use this practice carefully, by only making partial assertions about a client’s circumstances, and leaving it to the client to elaborate. In this way, they avoid intruding upon the client’s personal sphere, and maintain a positive relationship with her/him. More details can be found in Pino (2016a) and at this link: http://www.therapeutic-communities-talk.com/findings/sharing/knowledge-display-a-strategy-for-soliciting-tc-clients-to-share/ 3.2. Behaviour change. A major focus in TCs and other kinds of rehabilitation programmes is helping clients reduce behaviours that can be directly harmful to oneself and to others, and indirectly harmful to society at large. TC staff can invite clients to modify harmful or unhelpful conduct by directly criticising them. My research shows that regularly, in these cases, clients react defensively, and this hinders the possibility of promoting reflection on their behaviours. I have also identified a different practice that experienced staff use to circumvent this problem. Rather than criticising clients directly, the staff tell a story—which I have termed an anecdote—which exemplifies the kind of behaviour they are trying to criticise, but with no direct reference about a particular client’s case. The story has a moral end or upshot, which is left to the client to appreciate and relate to her/his own case. In this way, TC staff can give feedback to their clients without causing defensive reactions and, therefore, maintain a positive relationship with them. More details can be found in Pino (2016b), downloadable at: http://www.therapeutic-communities-talk.com/download/delivering-criticism-through-anecdotes-published-in-discourse-studies/?wpdmdl=326 3.3. Perspective change. Another essential part of therapy is to help clients modify their perspectives, that is, the ways in which they make sense of the social world, including their relationships with others. Similar to the activity of criticising client behaviours, mentioned above, the activity of criticising clients’ perspectives also results in clients’ defensive reactions and gets in the way of a fruitful process of reflection. I identified a particular way in which TC clients navigate this problem by inviting their peers to change their perspectives indirectly. Rather than criticising their peers’ points of view, these clients share their own experience—what they did or how they felt in the same circumstances—in a way that indirectly suggests a different way of looking at the same problem. These clients effectively talk about themselves; but their recipients can apply those experiences to their own cases and, eventually, reflect on their own circumstances in a new way. I have termed this communicative practice an I-challenge. Find out more in Pino (2017a), downloadable at: http://www.therapeutic-communities-talk.com/download/i-challenges/?wpdmdl=446 3.4. Conflicts. Whilst doing the analyses leading up to the results summarised above I identified several cases in which a TC member—staff or client—criticises another member directly. The recipient can react defensively and even, sometimes, counter-attack by criticising the one who had criticised her/him in the first place. In these cases, a conflict emerges, which can compromise the relationship between the group members involved. I have examined the processes through which these conflicts emerge (Pino, 2017b). In future research I will further examine how they can be de-escalated and resolved. 4. Conclusions. The findings reported here have far-reaching implications for the understanding and practice of professional and peer help. The project examined the internal anatomy of fundamental areas of therapeutic interpersonal communication. Across these areas, professional and clients have choice regarding different ways of implementing important therapeutic activities and solving recurrent communication problems. These choices have consequences for the management of relationships within the environment of the community. Several, if not all, of the problems examined here revolve around the management of the relational boundary between the giver and the recipient of help; the different ways in which the help-giver comments on the help-recipient’s experience or circumstances have consequences for the management of their relationship. The project identified less intrusive and more respectful ways of doing so. These practices can form the basis for more dignified ways of supporting vulnerable individuals, whilst promoting their participation and engagement in their therapeutic journey. The project also led to the design and delivery of evidence-based communication training, showing that it is possible to identify and teach better practice in these areas. Future research and training can build on these findings to further extend and enhance the understanding and the practices of professional and peer support. Although the findings of this project are based on the examination of one specific therapeutic setting, they have implications for the understanding and the practice of professional and peer help in other areas as well. ReferencesPino, M. (2016a). Knowledge displays: soliciting clients to fill knowledge gaps and to reconcile knowledge discrepancies in therapeutic interaction. Patient Education and Counseling, 99(6), 897-904. Pino, M. (2016b). Delivering criticism through anecdotes in interaction. Discourse Studies, 18(6), 1-21.Pino, M. (2017a, accepted). I-challenges: influencing others’ perspectives by mentioning personal experiences in Therapeutic-Community group meetings. Social Psychology QuarterlyPino, M. (2017b, under review). Complaining against each other: The emergence of conflict in Therapeutic-Community group meetings. Research on Language and Social Interaction
