Additional file 2: Results #1 – Intervention contexts that elicit and/or support engagement
Citation
Intervention summary
Main
Contexts that elicit
(Qualitative/Quantitative) psychosocial/employment and/or support
outcomes
engagement
Abbott et al.
1999.
Two groups were
compared: 1) A
Methadone Free at Intake
(MFI) group; and, 2:
Methadone Maintenance
Transfers (MMT) or those
who were on methadone
for a period of time. The
goal of the study was to
determine if enhanced
services would benefit the
groups. Both groups
received two treatments:
a) Community
Reinforcement Approach
(CRA) (problem-solving
skills, drug-refusal training,
communication skills etc.)
with referrals to the Job
Finding Club; and, b)
Standard Counseling (SC)
with referrals to
“resources in the clinic or
community” (p. 131).
(Quantitative)
For both groups of clients
(MMT and MFI) there
were improvements in
“drug, alcohol, legal,
employment, social and in
some measures of
psychiatric distress” with
the use of additional
services and this
continued up to the 6
month follow-up point (p.
129). At 6 months “the
two groups [MMT and
MFI] were comparable
with regard to psychiatric
problems,” legal problems
and both showed
decreases in depression
(p. 135).
1a) Client-centered
Abbott et al.
1998.
Three groups were
compared: 1) A
Community Reinforcement
Both groups (standard and
combined CRA conditions)
“showed significant
1a) Client-centered
Both groups (MMT and
MFI) were provided a
variety of services and
supports that appeared
to be tailored, at least to
some extent, to clients’
needs. For example,
clients received
focussed sessions on
“problematic issues
identified in the
treatment plan” (p.
131). In addition, they
were given social skills
training, and there were
specific sessions on
problem solving and
communication skills.
Clients were also
referred to employment
agencies and marital
counseling.
Appel et al. 2000.
Aszalos et al.
1999.
Approach (CRA) group
(counselling including
behavioral skills sessions,
job finding club, etc.); 2)
CRA plus relapse
prevention group; and, 3)
A Standard Counseling (SC)
group with referrals to key
resources in the clinic and
community. As there were
few “relapse prevention”
sessions at the 6-month
follow up, “the two CRA
groups were combined for
analysis” (p. 17).
(Quantitative)
This study included
counseling and
employment services with
a Vocational Rehabilitation
Counselor (VRC) at clinic 1,
which was compared with
standard vocationaleducation services at clinic
2. (Quantitative)
improvements” at the 6month follow-up on
almost all outcome
variables (e.g., depression,
social adjustment) (p. 27).
There is some evidence
that in all the groups
(standard and combined
CRA) clients were
supported in the
articulation of their
needs/issues and/or the
development of needed
skills. In addition, all
groups had access to
various services in the
clinic and community
(e.g., employment
services).
Outcomes were measured
by the amount of
vocational-educational
services (v-e) clients were
involved with. Vocationaleducational services
“increased significantly in
Clinic 1; net v-e
involvement increased
from 53 to 56% in Clinic 1
and declined in Clinic 2,
45-43%.…VRC services
contributed significantly
to v-e change among
patients not working at
admission” (p. 437).
1a) Client-centered
Evaluation of a 6-month
outpatient program with
methadone therapy.
According to the
researchers, “Patients
improved deficits in health
Limited discussion by
authors of why the
intervention in clinic 1
appeared to work. It
appears that services
were somewhat tailored
to patients’ situation
(e.g., if “ready” for
employment given
intensive counselling)
although it also appears
it was based, at least in
part, on counselors’
judgements of patient
readiness and
assessment of the
clients’ vocationaleducational prospects.
1a) Client-centered
Group and individual
therapy, case management
(e.g., assistance with
housing or legal situations)
and access to services
(e.g., psychiatric
consultations were
available). No control or
comparison group.
(Quantitative)
Bigelow et al.
1980.
Four groups were
compared: 1) Contingency
Management group; 2)
Emotionally-based
Behavior Therapy group; 3)
both of these; and, 4) a
control condition receiving
counseling (supportive
decision making).
(Quantitative)
and social indicators by
obtaining medical
coverage, keeping
outpatient medical
appointments, and
improving their housing
conditions” (p. 149).
There were no significant
differences found
between treatment
groups. The researchers
state that, “No differential
effects of the four
assigned treatment
modalities were evident in
between-group
comparisons on the
various outcome
measures. Overall, there
was little average change
in the treated group over
the 6 months of their
The researchers argue
that they “encouraged
patient investment and
ownership” suggesting
that there was some
interest in the clients’
needs and issues (p.
151). In addition, “An
optional weekly
spirituality group
was…initiated upon
patient request” (p.
152).
1b) Socio-economic
conditions
Responsiveness to
clients’ socio-economic
lives (e.g., case
management assistance
with housing and legal
situations); given
“information on
preferred shelters and
accessing emergency
food stamps”;
assistance with
transportation (bus
tickets) and if childcare
was unavailable they
could bring child with
them to the
intervention (p. 152).
1a) Client-centered
(Lack of)
Some limited evidence
pointing to why the
interventions did not
work. There was good
retention (78%
remained in treatment
for 6 months or more),
but it appears that the
context may have not
been client-centered
enough as it was the
counselors who
“selected specific
participation” (p. 432).
Carpenter et al.
2006.
The intervention involved
behavioral therapy and
contingency management
through individual
counseling. No control or
comparison group.
(Quantitative)
According to the
researchers,
“Approximately 48.3% of
the patients
demonstrated at least a
50% reduction” in selfrated depression and
clinic rated depression at
12 weeks relative to
baseline (p. 544).
Cohen et al. 1982.
Phase I: 6-week seminars
on antecedents,
No difference between
the two experimental
treatment goals, and
designed and
implemented treatment
techniques” (p. 430).
The supportive decisionmaking counseling,
which all participants
received (including
control group), may
have been what all the
participants wanted,
and hence no significant
differences between
groups. This supportive
counseling “consisted of
here-and-now based
discussion of [a] client’s
life situations, feelings,
problems and
alternatives, with
counselors providing
both suggestions and
emotional support” (p.
430) suggesting that it
was very client-centred.
1a) Client-centered
Intervention appears to
have been at least
somewhat tailored to
clients’ psychosocial
needs/skills (including
need for skill
development) with
therapy sessions on
“increasing activities in
rated important life
areas [and] developing
skills to increase
activities…” (p. 543).
1a) Client-centered
(Lack of)
Connett 1980.
consequences, and control
of drinking. Phase II: Two
experimental groups: 1) An
Abstinence Oriented
Insight group therapy; and,
2) A Drinking-oriented
Behavioral Modification
group therapy were
compared to 3) a control
group (individual
counseling sessions).
(Quantitative)
groups and control group
on such indices as
productive activity, days
worked, or “days of
hospitalization per
quarter” (p. 358). The
researchers note that “the
results of this study
document the generally
poor compliance of OA
[operative alcoholics] in
seeking and maintaining
therapy for their
alcoholism. It is of interest
that there appears to be
considerably less
resistance in their
participation in treatment
for their narcotic
addiction, as the retention
rates of OA did not differ
from NA [non-alcoholics]”
(p. 360).
Counseling with two
different types of
counselors: 1)
paraprofessional (group
CGA); and 2) professional
(group CGB).
(Quantitative)
Employment for patients
with paraprofessional
counselors “revealed a
greater percentage on
full-time employment”
but those with
professional counselors
“showed a larger
combined percentage of
occupational activities
when ‘school-training and
homemakers’ were
totalled” (p. 587–588).
This study provides
some evidence
supporting our finding
that if an intervention is
not client-centered, or
clients do not have an
opportunity to
articulate their
needs/issues,
engagement (including
attendance) will be low.
There was good
attendance with the
methadone program but
not the treatment
intervention (e.g., only
18 out of 84 participants
in the treatment groups
were involved),
suggesting clients were
not interested in the
intervention which
focused on therapy for
alcoholism. Also, the
seminars may not have
allowed the clients to be
actively involved in
dealing with their
particular issues so they
may not have been of
interest.
1c) Relationships
Although the results
were mixed, the findings
indicate that a greater
percentage of clients
counseled by
paraprofessionals
obtained full-time
employment possibly
because of a more
supportive counselorclient relationship given
that the
paraprofessionals had
more experience or
understanding of this
Coviello et al.
2004.
Comparison of two groups:
1) Vocational Problem
Solving Skills (VPSS) group
(based on the
interpersonal, cognitive,
problem-solving [ICPS]
theory); and, 2) a control
group using the same ICPS
theory but with a focus on
drug use.
(Quantitative)
Throughout the
intervention, clients had a
high level of motivation
for finding work (an
average of 7.70 out of 10)
(p. 2315). However,
according to the
researchers, “Overall,
there were no differences
between conditions in
motivation or action steps
for obtaining
employment… (p. 2317).
population than the
professional group.
Indeed, the researchers
suggest that, “the closer
social environmental
identification and
experiences of CGA
[paraprofessional]
counselors with this
type of patient
population may have
been more of an
influencing factor upon
patient progress in the
short run than had been
anticipated” (p. 589).
1a) Client-centered
1b) Socio-economic
conditions (Lack of)
The VPSS intervention
was tailored to allow a
client to “think through
his/her own problems
and select a range of
action-oriented steps
that could be helpful in
reaching a realistic goal”
(e.g., employment) (p.
2311). It appears,
therefore, to be clientcentered. (The control
group used the same
approach but was
focused on drug use).
However, the lack of attention to clients’
socio-economic
conditions appears to be
a key factor in why
there were no
differences in outcomes
between the groups.
That is, clients wanted
“off the books”
employment rather than
taxable employment.
The researchers note
Coviello et al.
2009.
that, “For many of the
clients the primary aim
of obtaining
employment was to
meet a financial need.
Participants obtained
sporadic employment
(day jobs) as a means to
cover daily expenses”
(p. 2318). The
researchers note that,
“attempting to measure
activities and motivation
that did not have
adequate validity or
appropriately represent
the client’s lifestyle and
desire to work” may
have been a
contributing factor to
the poor outcomes (p.
2320). The researchers
suggest for future
studies to consider that
“taxable employment
with little flexibility may
not be a desired or
attainable outcome due
to the complexity of
client lifestyle and the
unavailability of private
health insurance to pay
for methadone
treatment” (p. 2321).
Two groups compared
According to the
1a) Client-centered
using manual based
researchers, “While there Both groups appeared
Interpersonal Cognitive
were no differences
to be client-centered as
Problem Solving (ICPS)
between the integrated
the first component of
theory: 1) A control group
and control conditions,
each group was to
using ICPS was centered on both groups showed a
assess clients’ needs,
drug counselling; and, 2)
significant improvement in working with the client
an experimental group
employment
to understand barriers
using ICPS focused on
outcomes…at the sixto employment/
integrated employment
month follow-up” (p. 189). recovery, developing an
and drug counselling.
action plan etc. Indeed,
(Quantitative)
in both groups there
appeared to be support
for the client to think
Dansereau et al.
1996.
Two groups were
compared: 1) Individual
and group counseling
utilizing node-link
mapping/mapping
enhanced counseling; and
2) a control group
receiving standard
counselling. (Quantitative)
Clients in the mapping
group had “missed fewer
scheduled counseling
sessions, and were rated
more positively by their
counselors on rapport,
motivation, and selfconfidence” (p. 374).
through “his/her own
problems and select a
range of implementable
options that could
potentially be helpful in
reaching a realistic goal”
(p. 190). The authors
argue that one of the
reasons why there was
“no significant
treatment effect
between groups” is
probably because “both
groups received the
problem-solving
intervention, [and] the
control group could
have generalized these
strategies to finding
work” (p. 195).
1a) Client-centered
The mapping
intervention appears to
allow the client to
articulate their
needs/issues as maps
are used to “represent
interrelationships
comprising personal
issues and related plans,
alternatives or solutions
visually” that the client
and counselor discuss
(p. 364). Each map has
nodes that contain
“thoughts, actions, or
feelings, and named
‘links’ are used to
express their
interrelationships” (p.
364). Hence, some of
the improvements of
the mapping group over
the control group may
have been due to the
fact that mapping
allowed clients to
visually focus on
articulating their issues.
Farabee et al.
2002.
Four groups were
compared: 1) Cognitivebehavioral Therapy (CBT)
which used group
counseling; 2) Contingency
Management (CM) group
with individual meetings
and vouchers for
stimulant-negative urine
samples; 3) combination of
both CBT and CM; and, 4) a
control group, methadone
maintenance treatment
only. (Quantitative)
Participants “who had
been exposed to CBT
reported engaging in druguse avoidance activities
more frequently than did
subjects assigned to either
the CM or control
conditions…at treatment
end and at the 52-week
follow-up contact” (p.
348). However, at the 26week follow-up the
difference in drug-use
avoidance activities was
not statistically significant.
According to the
researchers, “While
participation in CBT
treatment increased the
likelihood that
participants would engage
in one or more of these
avoidance activities, it
appears that the subjects
in the non-CBT conditions
adopted some of these
activities as well” (p.349).
Drug use avoidance
activities included
exercise, avoiding drugusing friends etc.
1a) Client-centered
The CBT treatment
(groups 1 and 3) had
more positive outcomes
at treatment end and at
the 52-week follow up
than the CM or control
groups, and this may
have been because in
the CBT groups clients
were encouraged to
articulate how the topic
introduced was relevant
to them (p. 346).
1b) Socio-economic
conditions
Clients in the CM group
also had positive druguse avoidance scores.
This intervention
awarded clients with
vouchers. The
researchers argue that,
“As the voucher account
increased in value as a
result of stimulant-free
urine samples,
participants were
encouraged to ‘spend’
their savings on items
that could support drugfree activities. Although
participants were
strongly encouraged to
use the voucher
earnings to engage in
new prosocial, nondrug-related behaviour,
this group of patients
was far more interested
in using their earnings
for subsistence items”
(p. 346). These
subsistence items
included such items as
food (restaurant/fast
food certificates,
grocery store vouchers),
as well as clothes for
themselves or their
children and gas. It
appears, therefore, that
the voucher system may
have supported some
engagement with the
intervention.
Glickman et al.
2006.
All participants underwent
a peer-based 12-Step selfhelp program with spiritual
underpinnings, training in
running peer-led groups,
and attended 12-Step
oriented meetings. No
control or comparison
group. (Qualitative)
Joe et al. 1997.
The intervention
With this program, “the
transition into a
leadership/helper role
appears to mark an
important life transition
on the way to a successful
and new, more honest,
spiritually-anchored phase
of life” (p. 533). The
researchers argue that
taking on this leadership
role allowed the clients
“to assume a new, higher
function in a struggle with
the addiction” (p. 531).
Participants felt a
transformation occurring
that was related
progressively to a “more
secure recovery” (p. 532).
According to the
1a) Client-centered
The program was clientcentered insofar as
counselors supported
the clients in the
development of new
skills, and it was
“designed to afford an
opportunity for selfexamination” (p. 531).
1a) Client-centered
compared: 1) An Individual
and group counseling
group (utilizing node-link
mapping); and, 2) a control
group with standard
counseling. (Quantitative)
Joe et al. 1994.
Two groups were
compared: 1) Individual
and group counseling
sessions utilizing node-link
mapping to; and, 2) a
control group with
standard counseling.
(Quantitative)
researchers, 12 months
after the treatment ended
the outcomes were mixed.
The mapping group was
less likely than those in
standard counseling to
report illegal activity,
being jailed or arrested.
Yet, “measures of selfesteem, decision-making
confidence, and hostility
showed mapping clients
tended to rate themselves
more poorly than
standard
clients….However, overall
ratings at follow-up were
moderately positive on all
measures in both
counseling modalities”
(Discussion para 3).
Clients in the mapping
group had higher
counselor ratings than
those in the control group
on rapport, motivation
and self-confidence (p.
404).
This study suggests that
articulating one’s issues
through mapping may
have some negative
outcomes as “mapping
might have led clients to
see their psychological
and social strengths and
weaknesses in a more
critical (and perhaps
more realistic) light”
(Discussion para 3).
1a) Client-centered
Mapping was used to
help clients represent
interrelationships
between their ideas,
feelings and
experiences. Clients
worked with the
counselors in the
development of the
maps, and in this
intervention the “goals
were mutually agreed to
by client and counselor
in light of the client’s
unique history and
needs”, which
demonstrates clients’
involvement in
identifying or
articulating their
psychosocial issues (p.
395). It appears that the
better outcomes for the
mapping group were, at
least in part, because
the visual tool allowed
the mapping group to
articulate their issues
and concerns.
Kidorf et al. 1998.
This intervention involved
a mandatory employment
programme based on
contingency management
(e.g., more intensive
counseling if did not meet
employment goals). The
intervention included
counseling to help find
employment (paid or
volunteer). Two types of
counseling were offered,
individual and group. No
control or comparison
group. (Quantitative)
According to the
researchers, “Seventy-five
percent of the patients
secured employment and
maintained the position
for at least 1 month.
Positions were found in an
average of 60 days. Most
patients (78%) continued
working throughout the 6month follow-up” (p. 73).
1a) Client-centered
It appears that the
intervention was clientcentered as, “Group
counselors spent
considerable
time…developing
strategies for seeking
employment and other
constructive activity,
and praising efforts
toward meeting the
goal” (p. 78). In
addition, clients’ were
supported in skill
development as
individual counselors
assisted clients in
“completing
applications, creating
resumes, and identifying
job and volunteer
openings” (p. 78).
1c) Relationships
Lidz et al. 2004.
Three prevocational
training programs were
compared: 1) Vocational
Problem Solving
(interpersonal cognitive
problem solving theory); 2)
Job Seekers Workshop;
and, 3) combination of
both. (Quantitative)
While there were
improvements in
outcomes across the
groups, the researchers
believe the rise in
employment and decline
in depression is not
attributed so much to the
interventions but to
methadone treatment.
According to the
researchers, “all three
interventions appear not
to have improved rates of
employment above the
level that resulted from
methadone maintenance
treatment” (p. 2304). The
researchers argue that,
“None of the three models
produced significantly
greater employment or
better overall
rehabilitation” (p. 2287).
The researchers argue
that they allowed ample
time for “a positive
therapeutic
relationship” to foster
because the
intervention was
designed “to take effect
only after 1 year of
treatment in the
program” (p. 79). These
positive relationships
appear to have been key
to engagement with the
intervention as this
therapeutic relationship
was important to “the
successful management
of patient anger and
apprehension
associated with negative
contingencies” (p. 79).
1a) Client-centered
(Lack of)
The interventions were
not client-centered
insofar as the manuals
could not adequately
address the complex
barriers faced by some
clients (e.g., having to
explain past criminal
behaviours). The
researchers argue that,
“Some subjects faced
such complex barriers to
employment that
contrary to the manuals,
it was often not possible
to suggest realist
solutions during group
discussion” (p. 2303).
1b) Socio-economic
conditions (Lack of)
It appears that this
intervention context
was not responsive to
Magura et al.
2007.
Two groups were
compared: 1) A
Customized Employment
Supports (CES)
(counseling) group; and, 2)
a control group with
standard vocational
counseling (including
prevocational counseling,
working with patients on
hygiene issues, job seeking
and referrals to job
agencies).
(Qualitative/Quantitative)
According to the
researchers, the CES
group had significantly
better employment
outcomes than those
receiving the standard
vocational counseling.
They argued that the odds
of clients in the CES group
obtaining employment
were 2.3 times more likely
than those in the standard
group (p. 821).
clients’ socio-economic
lives. For example,
manuals did not
recognize low literacy
levels and video-taping
made some clients
uncomfortable as “they
lacked the selfpresentation skills to
keep up with the pace
of the programs” (p.
2302).
1a) Client-centered
Although both groups
were offered
individualized
interventions, the CES
group extended
supports “beyond
deficits in job
attainment skills and
vocational background”
to non-vocational areas
such as low self-efficacy
(p. 815). The greater
success of the CES group
appears to be due, in
part, to the fact that a
more intense
individualized program
was put into place that
was better able to
address the multiple,
complex psychosocial
and employment issues
and needs facing clients.
1b) Socio-economic
conditions
There was some
responsiveness to
clients’ socio-economic
lives (e.g., help finding
housing) as part of the
CES group.
1c) Relationships
According to the
researchers, the CES
McLellan et al.
1993.
Three groups were
compared: 1) A Minimum
Methadone Services
(MMS) group which
involved methadone only;
2) Standard Methadone
Services group (counseling
only) (SMS); and, 3)
Enhanced Methadone
Services (EMS) group
which included counseling
and extended on site
medical/psychiatric,
employment, and family
therapy services.
(Quantitative)
The SMS group had
“significant decreases in
illegal drug use…with
some additional changes
in alcohol, legal, family
and psychiatric problem
area status measures” (p.
1957). The EMS group had
the most improvements in
both drug use and
psychosocial outcomes
overall (including
employment, criminal
activity and psychiatric
status). According to the
researchers, “The EMS
group showed better
outcomes than did the
SMS group on 14 of the 21
measures” within the
Addiction Severity Index
(ASI) (p. 1957).
model used “highly
active engagement
strategies to build the
therapeutic alliance
with patients on which
counseling depends” (p.
815). One such strategy
was fieldwork or
“activities in which
counselor and patient
interact in the
community rather than
in the clinic” (p. 815).
1a) Client-centered
Both the Standard
Methadone Services
group (SMS) and the
Enhanced Methadone
Services (EMS) had
counselors help with
“the various problems
that were common to
most patients in
treatment” suggesting a
client-centered context
(p. 1955). However,
EMS seems to have
been most clientcentered insofar as it
provided multiple
services addressing
many aspects of clients’
lives including a focus
on employment. This
might explain, in part,
the better outcomes for
this group.
1b) Socio-economic
conditions
Individuals in the EMS
group were provided
with an employment
counselor who
“conducted a series of
workshops and group
sessions designed to
teach reading and
Najavits et al.
2007.
The intervention involved
a manual based group coled therapy for 12 sessions.
Eight opioid-dependent
women were part of the
intervention and the study
was conducted at an
outpatient methadone
maintenance treatment
program. No control or
comparison group.
(Pilot study Qualitative/Quantitative)
The researchers argued
that, “Results indicated
significant improvements
from intake to 2 months
later on key variables
most related to the
treatment” including
“impulsive-addictive
behaviour, global
improvement, and
knowledge of the
workbook concepts” (p.
9). Other variables (e.g.,
employment,
psychological problems)
“despite being nonsignificant over time, were
largely in the direction of
improvement…” (p. 9).
Nurco et al. 1995.
A comparison of: 1) A
Clinically-Guided Self-help
(CGSH) program with
weekly discussions (group
counseling), skills training,
social and recreational
activities, community
outreach activities, and
individual therapy; and, 2)
two control groups one of
which involved lectures on
HIV/AIDS with standard
treatment and the other
standard treatment alone.
(Quantitative)
According to the
researchers, the
experimental group
“demonstrated
statistically significant
changes in locus-ofcontrol beliefs, from
external to internal
causation, about personal
responsibility for drug
misuse. Members of two
control groups…failed to
demonstrate similar
changes” (p. 765–766).
prepare for a general
equivalency diploma”
(p. 1955). Helping to
address clients’ low
literacy and educational
levels might have added
to the more positive
outcome in this group
compared to the SMS
group.
1a) Client-centered
This intervention
targeted women and
focused on “themes and
psychoeducation
relevant to women” (p.
6). Therefore, it appears
to have been clientcentered drawing
attention to issues
specific to women’s
lives (p. 6). Not only was
there an 87% rate of
attendance (p. 9) but
researchers reported,
strong treatment
satisfaction suggesting
engagement with the
intervention (p. 5).
1a) Client-centered
In the experimental
group (CGSH) clients
were encouraged to
articulate issues “of selfdeclared importance to
them, e.g. employment,
family” suggesting that
this intervention was
client-centered (p. 769).
In addition, training “to
develop and refine
social and interpersonal
skills” was provided (p.
769), also suggesting a
client-centered
approach.
1c) Relationships
Platt et al. 1993.
The intervention
According to the
The researchers
contend that the
counselors were
charismatic and
committed to the
success of the program.
As well, they were
aware of clients’ issues,
and possessed core
interpersonal skills, such
as “empathy, respect,
and genuineness” (p.
770). The researchers
maintain that it is within
this environment of
positive relationships
that “clients are more
likely to overcome fears
and inhibitions about
everyday living and to
assume greater control
of their lives” (p. 770–
771). This suggests that
these positive
relationships were a key
factor in the
engagement process.
1a) Client-centered
Ronel et al 2011.
compared: 1) Group
Counseling (Vocational
Cognitive Problemsolving); and, 2) a control
group with standard
methadone treatment
services provided by their
clinic (e.g., methadone and
weekly individual
counseling). (Quantitative)
researchers, “At six
months post-intervention,
the experimental group (N
= 67) demonstrated a
significant increase in
employment rate (13.4%
to 26.9%); no significant
change occurred for
controls (N = 63)” (p. 21).
This intervention involved
The researchers argue
The experimental group
was tailored to clients’
employment
needs/issues, as the
participants were
“helped in clarifying
their own attractions
and barriers to work”,
and then the barriers
were used as “the basis
for specifying
individualized objectives
and plans for action” (p.
23). Researchers used
various strategies to
help clients articulate
their needs including
“exercises, group
discussions,
brainstorming, case
studies and role playing”
(p. 25).
1c) Relationships
In the experimental
group, participants were
able to “help each other
through structured
exercises which provide
important peer
feedback and support”
(p. 23–24). This appears
to have fostered
positive relationships
between peers and thus
may have supported
engagement.
1a) Client-centered
Rounsaville et al.
1983.
individual and group
counseling sessions
utilizing a 12-Step
approach. No control or
comparison group.
(Qualitative)
that there were at least
some positive results from
this intervention. For
example, clients would
“mutually support and
encourage each other”
when they “shared
reports about difficulties
they experienced”
suggesting positive social
relationships (p. 1146) The
researchers also argue
that, “In the course of the
program, members
learned to identify their
various feelings and
emotions, and they
gradually described the
practice of an alternative
behaviour (compared with
those they had before
entering TSP [Twelve-step
programme]) in response
to certain emotions like
frustration, anger or lack
of control over a
situation” (p.1146).
A comparison of two
groups: 1) A six-month,
At week 12 and 24 clients
in both groups had
The intervention
appeared to support
clients’ in articulating
their psychosocial
needs/issues as “efforts
were made to create a
group atmosphere of
unconditional
acceptance, support,
and warmth, in which
members could feel
comfortable and
uninhibited to share
their difficulties” and
encouraged clients to
articulate issues of
importance to them (p.
1142). According to
these researchers, “Each
group meeting opened
with a short period of
meditation, followed by
all members sharing
their current state of
mind” (p. 1142).
1c) Relationships
Clients were
encouraged to engage
in “mutual aid between
meetings” (p. 1142),
which appears to have
encouraged supportive
relationships among
clients.
1a) Client-centered
(Lack of)
Sees et al. 2000.
weekly course of Individual
Interpersonal
Psychotherapy Therapy
(IPT_ group; and, 2) A lowcontact treatment group
consisting of one brief
meeting per month.
Individuals were already
participating in a fullservice methadone
hydrochloride
maintenance program that
offers a range of services,
with a mandatory weekly
90-minute group
psychotherapy session (p.
629–630). (Quantitative)
positive results.
Researchers note there is
little in the findings to
suggest, “that individual
weekly short-term IPT
provided additional
benefit when added to a
methadone program that
already provided weekly
group psychotherapy” (p.
634).
Two groups were
compared: 1) A 180-day
methadone detoxification
with psychosocial therapy
and education sessions
group; and, 2) A
continuation of
methadone with substance
abuse group therapy and
individual psychosocial
therapy group.
There was a slight
difference in legal status
favouring the methadone
treatment group, or group
2. However, for
employment, family or
psychiatric functioning
there were no differences
between groups as well as
no change from baseline.
According to the
Both groups had low
attendance (38% for the
experimental group of
which 51% voluntary
withdrew; 54% for
control group). There
was little difference
between the groups in
terms of outcomes. It
appears that clients may
have received what they
wanted/needed through
the methadone program
(which included
mandatory weekly
group psychotherapy),
and did not want
additional services.
According to the
researchers most of the
clients “who dropped
out of the
psychotherapy
treatment study
remained in the
methadone program,
indicating that it was
the former treatment
that they failed to
become engaged with
and not the latter” (p.
634).
1a) Client-centered
(Lack of)
Clients’ psychosocial
and employment
needs/issues do not
appear to have been
sufficiently addressed.
The researchers suggest
they may not have
provided appropriate
psychosocial services,
Staines et al.
2004.
(Quantitative)
researchers, “Neither
treatment had a marked
effect on psychosocial
functioning” (p. 1309).
Two groups were
compared: 1) A
Customized Employment
Supports group (CES)
(counselling); and, 2) A
Standard Vocational
Counseling (SVC) group
with participation in
vocationally oriented
groups. (Qualitative and
Quantitative)
According to the
researchers, “Compared
with the standard
vocational service group
[group 2], patients in the
CES program were
significantly more likely to
have obtained any form of
paid
employment…competitive
employment…and
informal
employment.…However,
the two groups did not
differ significantly on
engaging in constructive
vocational activities other
than paid work” (p. 2273).
and argue that, “while
most patients were
marginally employed,
no vocational
rehabilitation services
were available” (p.
1309).
1a) Client-centered
1b) Socio-economic
conditions (Lack of)
Both groups were
provided individual
counseling which
appeared to be clientcentered. For example,
in the SVC group, the
individual counseling
activities were either
prevocational (e.g.,
working on hygiene
issues) or job seeking
“depending upon the
needs and desires of the
patients” (p. 2268). The
Customized
Employment Supports
(CES) appeared to
involve working more
intensively with
individuals to overcome
“the vocational as well
as non-vocational
barriers that hinder
their employment” (p.
2262). The counselors
were encouraged to
interact with clients in
the community and help
clients “meet a pressing
need (e.g., to find
housing)” pointing to a
client centred approach
(p. 2267). This more
intensive approach may
help to explain the
better outcomes for the
CES group as compared
Woody et al.
Three groups were
According to the
to the SVC group as the
CES group may have
been more engaged
with the various
activities that met their
needs. However,
according to the
researchers, the lack of
success in achieving
competitive jobs among
the CES group appears
to be due to the many
employment barriers
this population faces
such as, low levels of
education and job skills,
unstable housing, and
criminal justice system
involvement, which the
intervention did not
address.
1c) Relationships
The CES model engaged
strategies to increase
the therapeutic
relationship between
counselors and clients.
For example, “One
counselor frequently
accompanied patients
out in the community;
the other helped many
patients learn to use a
computer” (p. 2267).
1a) Client-centered
1983.
compared: 1) A
Supportive-expressive
Therapy (SE) group; 2) A
Cognitive-Behavioral
Therapy (CBT) group; and,
3) A drug counseling
group. (Quantitative)
researches, “The clear
overall result was that
patients in all three
groups showed
improvement in many
outcome measures,
including…crime days, and
illegal income and
improved psychological
function. These data
reflect changes observed
from the beginning of the
study to seven-month
follow up.…The data also
indicate that patients who
received psychotherapy in
addition to drug
counseling made more
and larger gains than
those who received drug
counseling alone.…The SE
patients’ gains were
especially prominent in
the areas of psychiatric
symptoms and
employment” (p. 643).
Woody et al.
Three groups were
According to the
All three comparison
groups appear to have
been, to some extent,
client-centered. For
example, the drug
counseling therapy was
responsive to clients’
needs insofar as
counselors helped with
such issues as legal
concerns. Supportiveexpressive therapy (SE)
works with the client to
identify issues, and in
cognitive-behavioural
therapy (CBT) the
counselor and patient
collaborate to correct
certain beliefs.
1c) Relationships
The researchers
speculate that a key
factor in the outcomes
was the development of
a supportive
relationship between
the client and the
therapist. They suggest
that the therapeutic
relationship “became a
direct substitute for
drug use” (p. 645).
1a) Client-centered
1987.
compared: 1) A
Supportive-expressive
Therapy (SE) group; 2) A
Cognitive-behavioral
Therapy (CBT) group; and,
3) A drug counseling
group. Follow-up
evaluation was done 6
months after treatment
ended. (Quantitative)
Woody et al.
1995.
Two groups were
compared: 1) A drug
counseling (DC) group;
and, 2) A Supportiveexpressive (SE)
Psychotherapy group.
Additionally, both groups
received drug counseling
which included referrals to
medical, social and legal
services when needed,
along with “exploring
current problems and
providing support…and
responding to acute
personal or social crises”
(p.1303). (Quantitative)
Zanis et al. 2001.
The intervention involved
researchers, “The results
from our analysis of
baseline to 12 month
follow up were similar to
those previously reported
for 7 month analyses. All
treatment groups [n = 3]
showed improvements.
However, the two
psychotherapy groups
showed more
improvements than the
drug counseling group
over a wider range of
outcome measures, with
marked changes in the
areas of employment,
legal status, and
psychiatric symptoms…”
(p. 595).
At one month follow up
both groups had improved
approximately the same,
however after 6 months
the counseling group (DC)
“…had lost many of its
gains or failed to improve
further, while the group
receiving supportive
expressive psychotherapy
showed continued
improvement in several
areas, to the point where
both statistically and
clinically significant
differences became
apparent” (p. 1307). The
SE group improved in
terms of employment and
psychiatric symptoms.
According to the
All three comparison
groups were, to some
extent client-centered.
The greater
improvements between
the two psychotherapy
groups may be because
they addressed more of
the clients’ psychosocial
and employment
concerns than the drug
counseling intervention.
1a) Client-centered
Both groups appear to
have been somewhat
client-centered as they
both provided referrals
to different services and
counseling to explore
current problems.
Group 2 appears to have
had better outcomes
with the addition of SE
therapy possibly
because clients were
encouraged to “feel
comfortable in
discussing his or her
personal experiences”
(p. 1303).
1a) Client-centered
Zanis et al. 2001.
Employment Case
Management (ECM), which
consisted of job
development and
advocacy, and counseling
and life skills training. No
control or comparison
group. (Qualitative)
researchers, “Nine of the
10 clients were employed
at the two-month followup assessment and six
maintained employment
at the eight-month followup. Moreover, three
clients were able to
successfully transition
from welfare to
competitive private sector
employment” (p. 67).
Two groups were
compared: 1) Individual
According to the
researchers, there was a
Clients were taught
what appear to be
relevant and needed
skills, such as “how to
use public
transportation, budget
money, decide on a
health insurance plan,
how to request a day off
from work, how to
communicate with
employers, etc.” (p. 69).
1c) Relationships
Positive relationships
between counselors and
clients appear to have
been established, as
according to clients one
strength of ECM was
“case management staff
cares” (p. 71). This
response may be due to
the mediation
counselors would often
undergo on the clients’
behalf. For example,
one “worked with a
local employer to
restructure the job
hours to meet the
client’s methadone
schedule” (p. 69).
1a) Client-centered
(Lack of)
counseling through
Vocational ProblemSolving Skills (VPSS) (a
cognitive-based
intervention) group; and,
2) a control group with
Interpersonal Problemsolving counseling which
included referrals to
employment programs if
requested by the client.
(Quantitative)
58.6% increase for VPSS
patients and 37.2%
increase for control
condition in employment
outcomes. However, after
controlling for predictor
variables, such as age and
motivation to work, it was
found that the VPSS
intervention did not
contribute significantly to
employment outcomes.
The VPSS intervention
group did not, at least in
part, recognize clients’
needs. As the
researchers argue, it
appears that clients
“wanted a job, and
wanted the counselors
to help them find a job,
not information on how
to problem-solve
vocational barriers” (p.
24). Additionally, “only
40% of the patients
assigned to the VPSS
condition across both
sites completed 8 of the
10 VPSS” sessions which
suggests they were not
engaged with the
intervention (p. 24).
Researchers argue that
many dropped out of
the program to search
for and obtain
employment.
1b) Socio-economic
conditions (Lack of)
The outcome measure
of full-time work does
not appear to have been
appropriate for this
population. Most of the
clients reported that,
“they were not
interested in legal, fulltime work because of
either institutional
barriers (e.g., potential
loss of Medicaid,
inability to obtain
methadone) or personal
barriers (did not want a
regular work schedule,
lack of reliable
transportation, etc.)” (p.
25).