When the non-sharing of therapeutic goals becomes the problem: The story of a consumer and his addiction to methadone

Mental health services typically follow standardized intervention protocols and systematic operating practices. This article explores what happens when a service relies exclusively on fixed practices rather than on the negotiation of objectives and the differentiation of procedures according to the needs of the user. The analysis of the narratives produced in first person by Oliver, a former substance user, emphasizes the need of constructing a therapeutic plan in close cooperation, promoting an user active role and strengthening his affiliation in the change process. In this specific case, the involvement of the user meant the identification of the peculiar meanings he attributed to the ‘substance of use’, which paradoxically coincided with the ‘therapeutic substance’ (methadone). Oliver’s story is an effective mirror for rethinking staff conduct when it assumes that the drug is therapeutic in itself, regardless of the way the person experiences and means it, it also offers a description of the interactive ways in which the relationship between a young person and service staff proved to be effectively therapeutic.