The purpose of the study was to investigate what factors cause outpatient substance abuse treatment to be discontinued. Data were collected from three areas: (1) client's background and substance use, (2) therapist's interpersonal functioning, (3) information on the interaction in therapy. The subjects (N = 66) were clients of an outpatient substance abuse treatment clinic. Four therapists participated in the study. Client's age and contact with problem users were factors which accounted for the discontinuation of treatment. Dropout decreased as age increased and became more prevalent as contacts increased. The therapist's interpersonal functioning and the quality of the interaction in therapy also affected on the continuity of treatment. Therapists' interpersonal functioning was associated with clients' ratings of interaction and with dropout: the more highly the therapist's interpersonal functioning was rated, the higher the clients rated the interaction and the less likely they were to discontinue treatment. If both the therapist and the client rated the interaction as successful, treatment was less likely to be abandoned. Conversely, if both parties assessed the interaction to be less successful, the more likely was treatment to be abandoned.
The client's pre-treatment expectations have an impact on treatment retention and effectiveness. Further effort should be made to study how clients' image of treatment could be improved and also how the commitment of the clients with multiple problems could be improved.
The purpose of the study was to investigate whether gender differences occur in personality traits or interpersonal functioning among substance abuse therapists in the same way as they do on population level. The subjects (N = 162) were therapists in Finnish inpatient treatment institutions. Female therapists (N = 119) scored significantly higher than male therapists (N = 43) on two personality factors: friendliness and openness to experiences. Women were also better than men in interpersonal functioning; they scored higher on all dimensions of it, namely, empathy, genuineness, respect for client, and concreteness.
Background: The study examined the effect of the early working alliance on outcome in outpatient substance abuse treatment.
Methods: A total of 327 clients and 33 therapists participated in the study.
Data were collected in southern and western Finland in outpatient treatment units (N = 7). The dependent variables were percentage of days abstinent and client satisfaction at six‐month follow‐up. The independent variables were both client and therapist alliance ratings of the first and third sessions. The client's percentage of days abstinent for the month preceding treatment was used as a covariate. Intra‐class correlation was used to measure between‐therapist variation.
Results: The main finding was that there was considerable between‐therapist variation in both the frequency of clients’ substance use and client satisfaction at follow‐up. The client's earlier substance use frequency was a significant predictor of the substance use frequency at follow‐up. Client satisfaction was significantly predicted by the client's rating of the early alliance.
Conclusions: More research on therapists is needed because between‐therapist differences seem to be associated with patient outcomes over differences within therapists. While the study confirmed that good early working alliance improves outcome during treatment without being linked to post‐treatment recovery, more research is needed also in that area.
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