Client Engagement Characteristics Associated with Problem Gambling Treatment Outcomes

Abstract

Previous research examining the factors associated with problem gambling treatment outcomes has examined client factors and to date, treatment characteristics, therapist factors, and client-therapist interactions have essentially remained unexplored. This study aimed to investigate how client engagement variables (client-rated therapeutic alliance, therapist-rated therapeutic alliance, number of sessions attended, and client commitment) relate to treatment outcomes (gambling and general functioning) in a sample of 475 treatment-seeking problem gambling clients using a series of hierarchical regression analyses. Client-rated therapeutic alliance predicted both gambling and general functioning outcomes, but therapist-rated therapeutic alliance only predicted general functioning outcomes. There was no significant relationship between number of sessions and outcomes, but client commitment predicted gambling outcomes. Client satisfaction only mediated the relationships between therapeutic alliance and treatment outcomes. Taken together, the findings indicate that client engagement characteristics, in particular the therapeutic relationship, are active agents of change in psychological interventions for problem gambling.Although relatively new and limited in scope, the literature investigating the efficacy of treatment for problem gambling provides some evidence that this disorder is amenable to intervention, with approximate overall success rates for psychological treatments estimated at 70% at six months follow-up, 50% at one-year follow-up, and 30% at two-year follow-up

Client engagement in psychotherapeutic treatment and associations with client characteristics, therapist characteristics, and treatment factors

“…Attendance was included in five multifarious definitions or assessments of engagement (Baydar, Reid, & Webster-Stratton, 2003;Dowling & Cosic, 2011;Korfmacher et al, 1998;Murphy et al, 2009) but was employed as a single proxy for engagement in 15 studies (Ammerman et al, 2006;Granholm et al, 2006;Joe, Simpson, & Broome, 1999a;Simpson et al, 1995;Simpson et al, 1997;Tryon, 1985;Tryon & Tryon, 1986;Tryon, 1986;Tryon, 1989a;Tryon, 1989b;Tryon, 1992;VanDeMark et al, 2010;Wang et al, 2006).…”

“…The therapeutic relationship was central to the definitions of engagement employed in five studies (Dowling & Cosic, 2011;Korfmacher et al, 1998;McFarlane et al, 2010;Murphy et al, 2009; and is also assessed by the Client Evaluation of Self and Treatment (discussed below). A rudimentary assessment of the therapeutic relationship was the number of home visitors' notations of their responses to clients' issues (McFarlane et al, 2010), which ranged from talking about the client's issue to making a referral to an appropriate service.…”

“…However, others (Dowling & Cosic, 2011;Korfmacher et al, 1998) have assessed both therapists' and clients' perceptions of the therapeutic alliance. The quality of the contact between nurses and patients in the study by Korfmacher et al (1998) was operationalized as clients'…”

Internet-Based Treatment of Pathological Gambling with a Three-Year Follow-Up

“…Attempts have been made to try to predict who will drop out (Dowling, 2009) and who will benefit from treatment (Dowling, 2009; Dowling & Cosic, 2010; Dunn, Delfabbro, & Harvey, 2011; Raylu & Oei, 2007). In Internet-based programmes this is an appealing idea.…”

Treatment Completion in a Cognitive Behaviour Therapy Service for Problem Gamblers: Clinical Outcome Study

“…Dunn et al noted treatment specific factors including non-compliance with homework tasks and a lack of readiness for change indicated greater risk of dropout [23,24]. The importance of the therapeutic relationship has been suggested to be important in achieving positive treatment outcomes [25]. In another study the CBT model used was reported to influence treatment completion.…”