The influence of the therapeutic relationship in treatment for alcohol dependency

Abstract

The substance abuse field has been slow to embrace research into the impact of the therapeutic relationship on treatment outcome. Limited previous research has demonstrated that therapist factors such as unconditional regard and empathy are associated strongly with treatment outcome. This study examined the relationships between client perception of the therapist and client characteristics; client response to out-patient relapse prevention treatment; and client outcome 3 months following treatment for alcohol dependence. One hundred and sixty-one male clients of a 3-week relapse prevention programme participated in the research, completing questionnaires assessing their perception of therapist regard, empathy, congruence, attractiveness, expertness and trustworthiness. Treatment outcome was measured at the conclusion of treatment, and 3 months post-treatment. Clients who were more anxious and those with poorer cognitive functioning appeared to perceive therapists as showing less unconditional regard, empathy and congruence. Self-efficacy and coping skills acquisition measured at the end of treatment correlated significantly with clients' perceptions of the therapist as empathic, congruent and displaying high regard for them. Treatment outcome at 3 months was associated significantly with degree of perceived therapist expertness and empathy. These relationships held when cognitive functioning and skills acquisition were controlled for. Self-efficacy moderated the relationships between regard and empathy and outcome, but not perceived therapist expertness. A lower than desirable follow-up rate limits the generalizability of the findings. The quality of the therapeutic relationship as perceived by clients appears to be associated with client characteristics, response to treatment and treatment outcome.

The female therapist and the client’s gender

“…Interpersonal factors are closely related to commitment to treatment and changes in substance abuse behaviour [41][42][43] . Therapists have been found to confront and criticize male clients more than do female clients in substance abuse treatment.…”

Look to the Relationship: A Review of African American Women Substance Users’ Poor Treatment Retention and Working Alliance Development

“…Both the therapist and client contribute to the development of the working alliance, but it has been the client's contribution that has garnered the greatest amount of empirical scrutiny (Ackerman & Hilsenroth, 2003;Horvath & Luborsky, 1993;Meier et al, 2005;Ritter et al, 2002). The American Psychological Association (APA) Division 29 Task Force on Empirically Supported Therapy Relationships asserts that therapist characteristics are just as central to working alliance development and significant enough to warrant investigations that explicitly identify therapist characteristics facilitative of a positive therapeutic relationship (Ackerman et al, 2001).…”

“…Ackerman and Hilsenroth's (2003) meta-analysis of therapist characteristics influencing the working alliance identified nine therapist attributes as facilitative of working alliance development in the general counseling population: empathy, positive regard, genuineness, trustworthiness, expertness, self-efficacy, flexibility, interest, and alertness. Three of these characteristics (empathy, positive regard, and genuineness) are also known as Carl Rogers' necessary and sufficient conditions of therapeutic change (Ritter et al, 2002). Findings of the APA Division 29 Task Force on Empirically Supported Therapy Relationships 666 T.A.…”

“…The Task Force classified empathy as "demonstrably effective" (Ackerman et al, 2001, p. 495), and positive regard and genuineness as "promising and probably effective" (Ackerman et al, 2001, p. 495). In the substance user literature, these characteristics also received empirical support as therapist characteristics associated with positive working alliance development (Najavits & Weiss, 1994;Ritter et al, 2002). Given the robust empirical findings that empathy, positive regard, and genuineness are therapist characteristics associated with positive relationship development across client type and treatment modality (Ackerman & Hilsenroth, 2003), they will be referred to as General Therapist Characteristics (GTCs).…”

The BRENDA Model: Integrating Psychosocial Treatment and Pharmacotherapy for the Treatment of Alcohol Use Disorders

“…It plays a considerable role in helping patients form the perception of a positive therapeutic alliance, which is associated with better treatment retention and outcomes. 43 Studies comparing the efficacy of various active approaches to psychotherapy typically fail to show significant differences. 44 This pattern has also held true for psychotherapy aimed at addiction.…”