Patient versus therapist alliance: Whose perception matters?

Abstract

Development of working alliance was examined for 25 opioid-abusing pain patients and their therapists. Patients participated in an 8-session intervention based on adherence strategies and employing a supportive, psychoeducational approach; methadone was prescribed for pain. Treatment goals included opioid analgesic adherence and decreasing pain, functional interference, and substance abuse. Patients and therapists completed the Helping Alliance Questionnaire-II following each treatment session. At baseline, patients' and therapists' scores indicated good alliance. Patient alliance grew significantly over time, regardless of addiction severity and independent of treatment outcomes. In contrast, therapist alliance grew only for patients without substance abuse co-morbidity and/or who had good outcomes. Patients' and therapists' alliance scores were consistent during sessions focused on emotional bonds but diverged during sessions that demanded behavior change, suggesting therapists may have reacted negatively to patients' lack of progress. Whether therapists' reactions to poor performers impacted subsequent patient outcomes is unknown, but should be investigated.

Adaptation of the Patient Feedback Survey at a Community Treatment Setting

“…These findings are similar to the results of the original CTN study 8 . In general, many studies have found a positive response bias among patients evaluating treatment satisfaction and/or therapeutic alliance, 1,11,25 even in prison settings where treatment is mandated 26 . In the current study, we also found that the PFS scores were higher for patients whose clinicians distributed the surveys than for those who obtained the survey from an administrator, supporting the notion that social desirability may play a role in how patients evaluate their treatment experience 27 …”

“…Evaluations of treatment satisfaction and therapeutic alliance by persons seeking substance abuse treatment are considered to be important performance indicators for addiction treatment programs. Although patients’ evaluations of their treatment sessions seem to be at best moderately related to substance use treatment outcomes, 1–6 several authors have written about the value of gathering data on how treatment seekers evaluate their treatment experience independent of their substance use 7–9 . Consideration of patients’ level of therapeutic alliance and treatment satisfaction may allow for organizational improvements; these include increased emphasis on building productive partnerships between staff and patients, and in turn promoting a “consumer‐friendly” atmosphere and greater treatment retention 10–12 .…”

Early working alliance in outpatient substance abuse treatment: Predicting substance use frequency and client satisfaction

“…But why was only the therapist's later rating of the alliance statistically significant in terms of client satisfaction? Earlier studies have suggested that therapist ratings are linked to their assumptions about the client's readiness for change (Bethea et al., 2008). In our study, most of the dropping out (75%) occurred before the third session, and therefore the participants at the third session were those who continued in treatment from the baseline.…”

Therapist and patient perceptions of alliance and progress in psychological therapy for women diagnosed with gynecological cancers.

“…There is evidence that higher levels of patient-rated social support are associated with greater patient-rated alliance (Garner et al, 2008). Intrapersonal factors associated with a less favorable client-rated alliance include greater symptom severity (Bethea, Acosta, & Haller, 2008). …”