Murray and Ferguson found that, as the user moved along these three stages, the role of the Harm Reduction worker shifted gradually “from a responsive, action-oriented role towards the role of providing ongoing problem-solving, counselling and encouragement." (Murray & Ferguson, 2003: 53). There is also a shift from strictly one-to-one support to peer group support. At all stages, the focus is on behaviours connected to the drug use, not the drug use itself (something Maté also stresses). Although the user is becoming more self-directed as they shift from survival mode to long-term thinking, an anchor relationship with a harm reduction worker is still very important: “just knowing that a friendly, accepting, non-judgmental person is always available can give users the confidence to take risks and make dramatic changes" (p. 52).
Andrew Tatarsky (1998) speaking from a psychotherapists’ perspective, describes a way of working that is similar to the way many literacy practitioners approach their work: the therapist would be actively committed to the person who seeks help, and should be experienced as an ally rather than a threat.
Not all Harm Reduction work conforms to these guidelines. In Advocate, Mentor or Master? John Egan draws on his work with Vancouver HIV prevention agencies, to examine the power relations between harm reduction workers and their clients (Egan, 2003). He identifies three roles that prevention workers take: the Advocate is client-centred and gives priority to the client's agenda — but this is limited because they don’t give guidance. The Mentor challenges the client's agenda and tends to intervene more than the advocate, encouraging them to think for themselves and “find concrete ways to improve their lives." (p. 6). Egan notes that "…instilling in her clients a sense of agency is more important than simply fulfilling their wishes." (p. 6). The third role prevention workers can take is that of a Master, trying to control their IDU clients.
Literacy workers, like Harm Reduction-oriented prevention workers, would do well to examine the role they take in their clients’ lives. While Egan notes that all three approaches represent a worker’s efforts to improve their client’s lives, he also asks:
(I)s it appropriate for these workers to direct their IDU clients, towards a 'better' life? Or is holding any notion of what would constitute a better life, itself inappropriate? If clients are disempowered, even ignorant, and workers dare not challenge them — based on following a wholly client-centred, advocacy-based agenda — isn't IDU oppression being perpetuated by an unwillingness to intervene? (Egan, 2003: 8)
Sarah’s response: Accepting, from a pragmatic perspective, that addiction is a reality does not mean that we throw up our hands and throw our clients to the wolves.