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Expectations and therapeutic practices in outpatient clinics for alcohol problems.

Summary 
 
This paper examines the interaction and therapeutic practices that therapists and patients engage in during initial consultations for alcohol problems in outpatient clinics. Therapists are seen to work with elicitation strategies which allocate responsibility to patients and require patients both to identify the nature of their problem(s) and suggest possible solutions. This is seen as part of a general psychiatric approach wherein little is offered by therapists in terms of giving direct advice and guidance. Patients, however, respond to therapists' elicitations in ways which actively seek an explanation, advice or guidance from therapists concerning their alcohol problems. For patients, the provision of such guidance and direction is seen as falling within the professional expertise of therapists. This divergence between patients' and therapists' models and expectations of treatment is examined. The role of advice giving and guidance in inducing patients' motivation is also considered in this paper.