A quantitative and qualitative exploration of client‐therapist interaction and engagement in treatment in an alcohol service

Abstract

Studies have suggested that differences in the effectiveness of therapists may be related to the therapist's ability to maintain a facilitative stance in the face of client resistance or hostility. The current study, examined a sample of audiotaped sessions from Hyams, Cartwright, and Spratley's (1996) study of engagement in an alcohol treatment service in an attempt to see whether the therapists' effectiveness at engaging clients in treatment was related to client-therapist interaction in assessment interviews. It was hypothesized that there would be (1) more overall negative interpersonal behaviour (2) more negative interpersonal behaviour by the therapist and (3) more negative interpersonal complementarity in interviews where the client failed to engage. Structural Analysis of Social Behaviour was used to assess the interpersonal behaviour of clients and therapists in three case comparisons, each of which focused on an engage and a non-engage case provided by one of three participating therapists. An additional series of follow-up qualitative case studies was carried out on the interviews where the client failed to engage. The results were mixed, with the qualitative analyses providing more support for the hypotheses than the quantitative analysis. It was concluded that problematic interpersonal processes might be harder to gauge in assessment sessions than later on in therapy and methodological recommendations were made for enhancing the likelihood of detecting problematic processes in future studies.

Early therapy interpersonal process differentiating clients high and low in outcome expectations

“…Moreover, the predictive power analysis indicated that if any hostile client behavior was present, there was a 100% likelihood the client would go on to have low outcome expectations. These findings are consistent with other SASB studies, which indicate that even minimal levels of client hostility are highly predictive of lack of engagement with treatment (Macdonald, Cartwright, & Brown, 2007) and poor outcome (Henry et al, 1986). …”

Interpersonal processes affecting early alliance formation in experiential therapy for depression

“…When one wishes to capture interpersonal process reflecting stable personality traits, any time sample of a person's interpersonal behavior from a session should validly represent the overall quality of interpersonal patterns in the whole session (Benjamin & Cushing, 2004). Some researchers have criticized this time sampling rationale, arguing that sampling clinically important therapy episodes is a more effective sampling method for capturing therapy process (Greenberg, 1986;Macdonald, Cartwright, & Brown, 2007). Moreover, since interpersonal process may develop within sessions, particularly in first sessions, examining change in interpersonal process within sessions is also a variable of interest.…”

“…However, when analyzing a therapy task for the first time, some consider it wise to focus initially on instances of success and failure on these tasks (Greenberg, 2007). It should also be noted that a sample size of 32 clients is relatively large compared to other SASB process studies (Critchfield et al, 2007;Henry et al, 1986;Henry, Schacht, & Strupp, 1990;MacDonald et al, 2007), and was large enough to detect significant and sizable effects. While a larger sample would provide the statistical power required for path models to test interrelationships or causal relationships among variables, our Step 1 .31** .31** 13.00** 1, 29 Pre-treatment Social Inhibition (.56**…”

The impact of early empathy on alliance building, emotional processing, and outcome during experiential treatment of depression

“…All studies have limitations. First, although a sample of 30 clients is comparable to samples typically used in process research (Critchfield, Henry, Castonguay, & Borkovec, 2007;Henry, Schacht, & Strupp, 1986, 1990MacDonald, Cartwright, & Brown, 2007), small samples limit statistical power and, as discussed earlier, our sample did not allow for adequate exploration of therapist or client effects. Still, power was not an issue for our present research questions as significant results were found, even when employing path analysis.…”