Exploring the lived experiences of therapeutic facilitators who work with people who use drugs

Abstract

Therapeutic facilitators in a substance use therapeutic community are not merely staff, but are also community members, and as such, their dedication often surpasses regular employment obligations. With the distinctive characteristics of the residents, the immersive community life, and the numerous roles they are required to undertake, the demands placed on Therapeutic Community personnel are substantial, while remuneration and advancement opportunities are limited. They work as part of a multidisciplinary team and involve family members in the therapy process by providing explanations and support. The objectives of this research are to observe the contingencies that potentially affect (negatively and positively) the wellbeing of therapeutic workers in local therapeutic communities as well as to uncover the strategies that are utilized to enable therapeutic facilitators to facilitate wellbeing. Literature shows those who work with individuals with SUD often experience specific psychological effects. These include preoccupation with clients, changes in fundamental beliefs, burnout and overload, and personal trauma reminders. They also tend to experience vicarious trauma, which leads to changes in cognitive schema and secondary traumatic stress, which involves emotional and post-traumatic responses similar to PTSD. A qualitative approach was taken for the study using the Interpretative Phenomenological Analysis (IPA) method. Data was collected through semi-structured interviews where prepared open-ended questions were asked to the participants. The findings revealed a number of challenges dealt by the therapeutic facilitators, some of which were unique to the local context. These were social disconnection, difficult client conduct, dealing with relapse and death, navigating multiple relationships, and exhaustion.. Supervision and team support were revealed to be the most preferred form of practicing wellbeing, along with maintaining boundaries and pursuing personal hobbies as outlets. The study highlighted the importance of a supportive community, adequate supervision, and the ability to detach from work-related events for the wellbeing of therapeutic facilitators and their ability to support their clients effectively. The study makes some recommendations for both service development and further research.