The Drug and Alcohol Findings ‘Old Gold’ archive contains summaries and analyses of seminal studies from the past. The latest to be carefully dissected by Editor Mike Ashton is a hidden gem from the late ’70s, which suggests that bolstering counsellors’ expectations promotes commitment to treatment and recovery among even the ‘least promising’ of clients. Read the edited version below, and see the full article here.

How is recovery fostered? Is it the product of a person’s motivation and commitment? Is it the outcome of interactions with others? A study published in 1977 in Alcohol Health & Research World investigated whether people with drinking problems who were socially and economically disadvantaged – referred to at the time as “disadvantaged alcoholics of skid-row status” – could be motivated to recover better when their counsellors held more favourable expectations. To test this proposition, counsellors at three government-sponsored US rehabilitation units were falsely led to believe that certain clients were highly motivated to accept counselling and as a result could be expected to show “remarkable recovery”.

Original paper: Effect of counselor expectations on alcoholic recovery. By George J. Leake and colleague. Published in Alcohol Health & Research World (1977).

Also see: Drug and Alcohol Findings summary and analysis of the paper.

Across eight dimensions which assessed the clients’ response to therapy, counsellors rated the ‘most promising’ clients significantly higher than their peers. The ‘most promising’ were seen as:

  • being more motivated to accept counselling
  • being more punctual in attending appointments
  • presenting a neater or more attractive appearance
  • being more able to exert self-control
  • being more ambitious
  • being more cooperative
  • trying harder to stay sober

Furthermore, fellow clients – who were unaware about the ‘most promising’ label – identified people in this cohort as those they would most like to talk with, be with, who had the best overall recovery, and who had been alcohol-free for the longest period of time.

The authors concluded that more favourable attention from counsellors may have led to other indirect and subtle recovery incentives for the spotlighted clients, for example, via the reactions of their fellow clients.

Substance use and substance-related problems were not assessed in the study, and neither were longer term post-therapy outcomes. This leaves it unclear whether the process of raising expectations produced a real improvement in recovery prospects. It is certainly possible that the act of distinguishing the dozen ‘high potential’ clients from the majority was an essential ingredient in promoting the progress of these clients. However, if therapists were trained to have high expectations of all clients, presumably that ingredient would no longer be present.

Still, the findings of this study suggested to the authors that counsellors should be made aware of the effect of their expectations, and, if possible, trained in developing and communicating high expectations for clients’ potential for recovery.

Across a caseload, instilling optimism is, on balance, likely to be a positive thing. There is, however, the potential for that same optimism to become a negative force if it leads to disillusion and distrust in the event that treatment fail to bring about the desired improvement. Setting the recovery bar too high can engender expectations of client failure among staff – negativity which may be communicated to clients. Conversely, setting the bar lower could engender optimism that even multiply-disadvantaged patients can succeed.

This study was small, and one must be careful when drawing conclusions from small studies. However, the implications that staff attitudes can influence outcomes is an important one – particularly at a time when workforce development and training is itself in the spotlight.

edited by Rob Calder and Natalie Davies

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