The influence of therapy alliance and treatment motivation in patients with Cluster B personality disorders on incidents in forensic hospitals

Abstract

Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

VR-assisted aggression treatment in forensic psychiatry: a qualitative study in patients with severe mental disorders

“…Most participants described the professional relationship in a positive way, highlighting aspects such as open communication and feeling safe during the treatment. This can be related to what in psychological treatment literature is referred to as therapeutic, or working alliance ( 64 , 65 ). For example, having the therapist describe clearly what was going to happen in a role-play could lead to increased feelings of safety, even in situations that could be challenging for the participant.…”

“…In terms of agreement on treatment goals, an aspect commonly described as a crucial part of the working alliance ( 64 , 65 ), several participants found it difficult to recall the specific treatment goals. This can be related to several aspects, e.g.…”