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Single session therapy (SST) is an increasingly popular approach to mental health treatment that aims to address clients' presenting difficulties in a single appointment. However, experiential approaches to SST are limited. In this paper I describe the theory and practice of "chairwork" – an integrative, action-focused method of intervention centred on the concept of self-multiplicity – and outline how these procedures can be coherently applied in a single-session format. A preliminary protocol for delivering single-session chairwork (SSC) or "brief dialogical psychotherapy" is presented, alongside a case illustration that demonstrates features of this approach. Finally, directions for future research and the continued development of chairwork as a psychotherapeutic modality are considered. [ABSTRACT FROM AUTHOR]

Little is known about the relationship between treatment organization characteristics and client outcomes or drug-related harms in community opiate substitution therapy. In the absence of sufficient scientific evidence, the organizational configuration of addiction treatment services is often decided on an ad hoc and sometimes politically motivated basis as the evaluation of the impact of policies or practices on clients at the organizational level is limited. The objective of this multi-site cross-sectional study was to identify and understand how client characteristics and staff perceptions of organizational functioning related to client engagement in community-based opiate substitution therapy services in Ireland. This paper reports on a cross-sectional survey of clients (n = 262) and staff (n = 132) questionnaires across 12 discrete community-based prescribing service providers (organizations) in Ireland. Measures of client engagement in treatment were shown to be higher in organizations with more positive staff ratings of organizational functioning. In particular, in organizations where staff reported having greater job autonomy, clients reported better overall engagement. Specifically, greater staff autonomy in organizations related to greater levels of treatment participation (p = 0.034), treatment satisfaction (p < 0.001), and better rapport with staff (p < 0.001). Clients who were the longest in treatment expressed significantly poorer rapport with staff (p = 0.44) and were less likely to seek out support from peers (p = 0.023), while those in stable accommodation reported greater participation in treatment (p = 0.009). Levels of peer support were not related to organizational characteristics, but clients with lower levels of education (p = 0.002) and those in early treatment (p = 0.017) were more likely to seek support from peers. The findings establish the importance of assessing organizational and client attributes as part of an overall strategy for enhancing the quality of treatment. This paper provides valuable information for policymakers and provides an ample basis for further exploration of how treatment organizations work, and not just that they work. Policymakers and planners need to consider introducing specific interventions for clients or staff in the context of a 'whole systems' approach. From an organizational and planning perspective, this should involve further consideration of measures that relate to increasing staff's sense of autonomy. This paper provides further evidence that the success of policy-making or planning relating to treatment organizations can be successfully measured at the client and organizational levels. [ABSTRACT FROM AUTHOR]

Many music therapists propose that chaos, such as destructiveness and disintegration, could thwart music therapy group processes and should be minimised or resolved. From a paradoxical approach, however, chaos is understood as a transformative complement to ordered, formative music therapy experiences. The research in this paper explored how music therapists and adolescents could engage with chaos as a resource in music therapy groups. From a paradoxical approach, the music therapist--researcher facilitated two short-term group music therapy processes with nine young South Africans from under-resourced and often violent communities, referred for committing offences. The researcher utilised crystallisation, including constructivist grounded theory, participatory action research, and abduction, to analyse how group members could engage with chaotic group experiences. Findings, constructed through a cyclical process of data collection, analysis, and inclusion of group feedback, are presented in a matrix. The matrix shows how groups could utilise chaos to explore multiple possibilities for responding to challenges. They expressed themselves courageously and played unconventional group roles through their musicking and participation. They juggled paradoxical tensions between observational and active, integrative and disintegrative, engagement styles. This supported their transformation in the group, and potentially within the chaotic South African context. Music therapists can use the matrix to support adolescents in music therapy groups to engage with chaos as a transformative resource. They can accompany young people through offering holding, resources and collaborative support. When it is safe, music therapists may allow or encourage chaos that empowers adolescents to cope with challenges independently. [ABSTRACT FROM AUTHOR]