title: Overcoming professionals' challenging experiences to promote a trustful therapeutic alliance in addiction treatment: A qualitative study.
abstract: A good therapeutic alliance plays a major role in the healing process. Professionals working in addiction treatment report high levels of psychological distress related to work and this may challenge the establishment of a trustful therapeutic alliance, and lead to a loss of care quality provided to service users. The purpose of this study was to investigate the experience of specialized professionals, its effects on trust and the therapeutic alliance, and the means to restore them.
  
  
  
  We conducted a qualitative study using a semi-structured questionnaire and a narrative tool. Discourse was extracted from focus groups and individual interviews and analyzed following the Interpretative Phenomenological Analysis method.
  
  
  
  Twenty-six professionals from three addiction treatment centers in the Paris area were interviewed.
  
  
  
  The difficulties weighing on the care alliance were described by the participants in terms of their nature, their effects and means to overcome them. Emotional drain leads to a climate of relational distrust and the temptation to desert or over-control patients. Teambuilding, specific training and self-care are viewed as means to restore a therapeutic alliance based on an appropriate type of trust.
  
  
  
  Distrust deriving from professionals' challenging experiences may lead to worrying consequences. Promoting democratic organization of care structures, specific training, and also responsible self-care on the part of professionals could help to restore a type of trust that helps to establish a therapeutic alliance suited to service user individualities. This could ultimately be beneficial for user care, professional wellbeing and team functioning.
authors.affiliation: APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France; Ile-de-France Regional Center for Bioethics, 1 rue Claude Vellefaux, 75010, Paris, France. Electronic address: aymeric.reyre@aphp.fr.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Reyre
authors.affiliation: APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France. Electronic address: raphael.jeannin@aphp.fr.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Jeannin
authors.affiliation: Roger Prévot Psychiatric Hospital, Department of Psychiatry, 5 avenue du Docteur Fleming, 92600, Asnières sur Seine, France. Electronic address: myriamlargueche@gmail.com.
authors.forename: Myriam
authors.initials: M
authors.lastname: Largueche
authors.affiliation: CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France; APHP-Cochin University Hospital, Department of Psychiatry, Paris 5 SPC University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: marie-rose.moro@aphp.fr.
authors.forename: Marie Rose
authors.initials: MR
authors.lastname: Moro
authors.affiliation: APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France. Electronic address: thierry.baubet@aphp.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Baubet
authors.affiliation: APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France. Electronic address: olivier.taieb@aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Taieb
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D016739:Behavior, Addictive / Q000628:therapy; D002055:Burnout, Professional / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Compassion fatigue; Delivery of health care; Personnel management; Professional-patient relations; Qualitative research; Substance related disorders