THERAPIST'S LEVERAGE

THERAPIST'S LEVERAGE

A number of factors can markedly increase or decrease the therap st's leverage during the recruitment effort.

Principle 14: The chances for successful family recruitment are increased if the therapist does the recruiting. There are several advantages to this. First, it avoids the problem of passing the family from one treater to another, with the accompanying increase in dropouts; the process is not diluted between an intake worker or recruiter and a therapist. Second, as mentioned earlier, by seeing the family during engagement the therapist can sell himself, helping to instill trust and assuage fears about being blamed and so forth.It is probably an advantage if the therapist is of the same race as the family. Our research design dictated that, whenever logistically possible, therapist and family should be matched as to race. This was achieved in 84% of the cases. While we feel that such matching may be less important during the actual therapy, it did seem to help at the time of recruitment. In addition to getting around the barriers that can occur in many instances when people of different races interact, it facilitated the task of getting information. Often our therapists made visits to the home or neighborhood to locate the IP or his family, and being of similar race engendered more cooperation from relatives and neighbors. The safety factor also cannot be ignored. Many of the families lived in "rough- neighborhoods, and it could actually be dangerous for a Black man to be walking around at night in a White

neighborhood, or vice versa.*

Principle 15: The therapist should be the primary treater of the index patient and his family. Below, in Chapters 6 and 16, we state that we believe family therapy will fail with these cases without this provision. It is likewise extremely important in the recruitment effort. In the early days of our project the IP had both a drug counselor and a therapist. The procedure was for the IP to become enrolled in the clinic and have his program and medications deter-mined in conjunction with his drug counselor. Then the counselor would serve as a kind of middleman or "matchmaker- in introducing him to the family therapist. (In the meantime the counselor con-tinued with the patient in monitoring therapeutic issues, providing individual counseling, and the like.) This procedure frequently fell on

its face 

The decision was made for the therapist to also function as drug counselor for those cases selected for our program. This modification was crucial: wearing both hats, the therapist was brought into the treatment process immediately upon intake. As mentioned earlier in this chapter, he had the advantage of being the first treater en-countered by the client. He had the added leverage of control over decisions about medications such as methadone. With the advent of the dual role model, a major recruiting hurdle was removed, leading to a marked decrease in the amount of effort needed to engage families, and an increase in the rate of recruitment success.