Therapists' first impression of treatment motivation moderates the relationship between the client‐rated therapeutic alliance and drinking outcomes during treatment

Abstract

Introduction:First impressions can influence interpersonal relationships for extended periods, with negative first impressions leading to more negative judgments and behaviors between individuals months after their initial meeting. Although common factors such as therapeutic alliance (TA) are well studied, less is known of the potential influence of a therapist's first impression of their client's motivation on TA and drinking outcomes. Based on data from a prospective study of the perceptions of the TA among clients receiving cognitive-behavioral treatment (CBT), this study examined how therapists' first impressions may moderate the relationship between client-rated TA and drinking outcomes during treatment.Methods: One hundred fifty-four adults participated in a 12-week course of CBT and completed measures of TA and drinking behaviors following each treatment session.Additionally, therapists completed a measure of their first impression of their client's motivation for treatment following the first session.Results: Time-lagged multilevel modeling revealed a significant within-person TA by therapists' first impression interaction that predicted percent days abstinent (PDA). Specifically, among participants rated as lower on first impressions of treatment motivation, higher within-person TA predicted greater PDA in the interval prior to the next treatment session. Within-person working alliance was not associated with PDA among individuals rated higher on first impressions of treatment motivation who demonstrated higher PDA throughout treatment. Furthermore, significant betweenperson TA by first impressions interactions were found for both PDA and drinks per drinking day (DDD), such that among individuals with lower treatment motivation, TA positively predicted PDA and negatively predicted DDD. Conclusion:Although therapists' first impressions of a client's treatment motivation are positively associated with treatment outcomes, clients' perception of the TA may mitigate the impact of poor first impressions. These findings highlight the need for additional nuanced examinations of the relationship between TA and treatment outcomes, emphasizing the contextual factors that influence this relationship.

First impressions count: Therapists’ impression on patients’ motivation and helping alliance predicts psychotherapy dropout

“…The single-item assessment of patients' motivation presumably tap a similar construct as the Helping Alliance Questionnaire used in Sample 1 (which includes questions such as "I believe that the patient is sufficiently motivated for treatment" or "I have the impression that the patient is affectively responsive to my therapeutic interventions"), again underlining the importance of motivational factors in therapy. Low motivation and/or dissatisfaction with the treatment has also been shown to be one of the main reasons for therapy dropout in outpatients (e.g., Bados et al, 2007) and to moderate the relationship between patient-rated therapeutic alliance and treatment outcomes in a cognitive-behavioral treatment (e.g., Rivera et al, 2023). Also, therapists might be adept at assessing which patients are suited for or able to adjust to the particular treatment concept of an inpatient setting, which might guide the impression in their assessment of patients' overall motivation.…”