Therapeutic alliance in psychological treatment for depression and alcohol use comorbidity: The client's perspective

Abstract

This qualitative study explored the treatment experience and the therapeutic relationship of participants receiving an integrated psychological treatment for comorbid alcohol use problems and depressive disorders. Semistructured interviews targeting experience of therapy and the relationship with the therapist were carried out with seven participants. Transcripts were analyzed using Interpretive Phenomenological Analysis to reveal major themes. Four major themes were identified. “Nature of the relationship” describes the importance of the client's perception of the therapeutic relationship experienced, “Confidence in therapy” and “Acknowledgment of experience” address components assisting the development of a positive alliance, and “Meeting unmet needs for connection” illustrates the importance of a positive therapeutic relationship for this population. Participants thought that clinicians would benefit from a good understanding of the role the alliance relationship plays within comorbidity treatment, of the need this relationship meets for this population, and the importance of engendering confidence in therapy and recognizing client perspectives.

Establishing an optimal working relationship with patients with an antisocial personality disorder. Aspects and processes in the therapeutic alliance

“…Some of these factors are generic and important for establishing a good TA with patients in general, such as showing interest, respect, and genuineness (Blasko et al, 2018; Hatcher, 2010; Nienhuis et al, 2018; Wampold et al, 2017). These factors have been found to be important in studies involving patients with anxiety disorders, depression with comorbid alcohol use problems, and personality disorders (Bender, 2005; Knock et al, 2021; Luong et al, 2020). On the other hand, other factors, such as clarity, transparency and trustworthiness, appear to be more specific to personality disorders in the dramatic or erratic cluster and of particular importance for patients with ASPD (Bender, 2005; Morken et al, 2022).…”

Patient‐ and therapist‐rated alliance predict improvements in posttraumatic stress disorder symptoms and substance use in integrated treatment

“…Bauer et al (2022) focused on Black/African American women in the same sample as Ruglass et al (2012) and found that higher education and more treatment experiences predicted higher alliance scores early in treatment, but higher alliance scores did not mediate the relationship between early predictors of alliance and treatment outcomes. Other studies on comorbid populations, namely, alcohol use disorder and major depressive disorder, demonstrate that patients' and therapists' perception of alliance are differentially associated with outcomes (Knock et al, 2021; Richardson et al, 2018). Richardson et al (2018) found therapist‐rated alliance predicted improvement in depressed mood but not alcohol use, whereas patient‐rated alliance had no impact on depressed mood or alcohol use.…”