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The study explored whether there are key skills that staff use to relate to service users which help with the formation of social bonds, which in turn leads to increased levels of service user engagement and retention. Data for the study was collected through a literature review, ethnographic observation, interviews and focus groups with staff and service users. The findings showed that staff are successful at engaging and retaining service users and it is their ability to form strong social bonds which is the key to its success. This is achieved through the philosophy of the project which is made up of three central tenets: a non-punitive approach, person-centred care and trauma informed care. The person-centred care approach facilitates the formation of a partnership between staff and service users in which they work together to achieve personalised recovery goals unique to each individual service user. The non-punitive approach stipulates that service users are not punished or judged for having a relapse, which results in the reduction of shame and the promotion of honesty. This non-punitive stance is experienced by service users as facilitative to their recovery, with some participants reporting that this approach was less evident in other models of addiction treatment. Trauma Informed Care allows service users to seek appropriate treatment for any possible underlying issues they may have, allowing them to fully engage in the service. The three interrelated strands of the philosophy produce an approach to the treatment of substance misuse that is considered to be unique and different to many mainstream addiction models and provides a platform for the formation of social bonds. There are some trade-offs as a result of adopting such a philosophy. It was discovered that staff place a large emphasis on trauma informed care; it is commendable that staff have committed to an approach which endeavours to identify people who have been exposed to trauma and are impacted by symptoms of Post-Traumatic Stress Disorder, as well as their recognition of the value of referral to appropriate treatment services. Given that there are a number of other confounding factors which may also be decisive, it is recommended that staff consider a balanced approach which remains open to other factors besides trauma such as the community reinforcement approach, motivational interviewing and the person centred approach. Secondly, the desire to unconditionally support service users while supportive and empowering has the possible drawback of fostering dependency and impeding autonomy. It is recommended that the balance between high levels of support and promoting independence continues to be a central element of the service approach to active discharge planning. Finally, the research identified a need to upskill in areas such as mental health and couple counselling to further support service users who may have dual diagnosis or who are experiencing relationship problems due to substance misuse.

Mental health is a pressing issue for society with approximately 700,000 of the Irish population being affected by a mental health problem over the course of their lives. Despite the extensive demand and the national reformation agenda recent reports indicate that patients are unsatisfied and readmission rates remain consistently high indicating that services do not enable recovery. Psychoanalysis has demonstrated that to enable positive change it is essential to manage transference. Transference is experienced in the immediate reactions of liking or disliking influential Others; often the subject who we suppose has knowledge that will benefit us. In services this Other is usually the health care professional. Managing transference requires a connection between consciously expressed expectations and unconscious desire. Health care delivery takes place within a therapeutic professional relationship placing responsibility on staff to acknowledge and address the quality of the relationships they have with service users. The reviews of service user satisfaction and the consistent readmission rates indicate that health care professionals are unskilled at forming positive therapeutic relationships. The aim of this study is to investigate the current management of transference and to make recommendation in relation to how recognition and management of transference may have positive outcomes for service users and providers. Following a review of relevant literature, a qualitative methodology was designed and data collected by interviews and non-participant observation in an acute mental health service. The data were analysed with a Freudian/Lacanian theory of the subject. Findings were grouped under four formulations, transference, language, groups and leaders and resulted in a set of recommendations. Key findings indicated that the act of caring provokes overwhelming anxiety in staff resulting in the patient being viewed as an object rather than a subject. Transference is unacknowledged and unmanaged and emerges in a negative form which contributes to the mismanagement of critical incidents. Staff are more concerned about maintaining the system that engaging with patients. Some professional groups lack language to describe their work resulting in the retention of patients as minors. Staff speak for rather than with patients. However with appropriate interventions for staff such as psychoanalytically informed supervision alongside a shift to a post-modern philosophy of care positive change could be achieved.