Predicting the early therapeutic alliance in the treatment of drug misuse

Meier, Petra; Donmall, Michael; Barrowclough, Christine; McElduff, Patrick; Heller, Richard F

doi:10.1111/j.1360-0443.2005.01031.x

Cited by 81 publications

(66 citation statements)

References 45 publications

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“…Many of the psychosocial variables included in this study because of their known or suspected relationship with the alliance (Meier et al, 2005b) have been shown to be equally valuable predictors of length of retention, although sometimes the direction of effects was not as we had anticipated.…”

Section: Discussionmentioning

confidence: 90%

The role of the early therapeutic alliance in predicting drug treatment dropout

Meier

Donmall

McElduff

et al. 2006

Drug and Alcohol Dependence

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125

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Background: To investigate the role of the therapeutic alliance in predicting length of retention in residential drug treatment. Methods:The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Counsellor and client information was assessed at intake, and the average total scores of client and counsellor ratings on the WAI-S (obtained during weeks 1 to 3) were use as the alliance measure. Length of retention and treatment completion (stay beyond 90 days) were used as measures of retention.Results: Clients with weak counsellor rated alliances dropped out of treatment significantly sooner than clients with strong counsellor-rated therapeutic alliances, whether or not the model adjusted for individual counsellor effects and potential confounders including psychological wellbeing, treatment motivation and readiness, coping strategies, and attachment style. The client rated alliance did not predict length of retention. Apart from the alliance, pre-treatment crack use, secure attachment style and better coping strategies were associated with shorter retention, whereas greater confidence in treatment, older client age and better education predicted treatment completion. Counsellors with greater experience of delivering drug counselling retained clients longer. Conclusions:The findings of this study stress the importance of treatment professionals attending to the therapeutic alliance in drug treatment, as counsellors' alliance ratings were found to be amongst the strongest predictors of dropout. Using alliance measures as clinical tools may help treatment practitioners to become aware of the risk of disengagement early on. Prospective studies are needed to evaluate whether strategies of reallocating clients with poor alliances to different counsellors lead to improvements in retention.

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Section: Discussionmentioning

confidence: 90%

The role of the early therapeutic alliance in predicting drug treatment dropout

Meier

Donmall

McElduff

et al. 2006

Drug and Alcohol Dependence

Self Cite

125

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“…While greater substance abuse severity (Belding et al, 1997) and lower motivation to change (Connors et al, 2000) have a negative impact patient on alliance, patient recognition of drug-related problems positively predicts patient alliance (Broome, Knight, Knight, Hiller, & Simpson, 1997). Therapists with more education and credentials develop stronger working alliance with their patients (Conners et al, 2000;Meier, Donmall, Barrowclaugh, McElduff, & Heller, 2005) and patients report stronger alliance with therapists in recovery (Meier et al, 2005). As these factors influence alliance development, they should be considered when evaluating the efficacy of various drug treatments.…”

Section: Introductionmentioning

confidence: 99%

Patient versus therapist alliance: Whose perception matters?

Bethea

Acosta

Haller

2008

Journal of Substance Abuse Treatment

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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.

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“…27 Social support and the treatment attitudes of key members of the patient's social network may also influence a patient's decision to accept or decline treatment. 28 Knowing others who have been on treatment, and their experience with treatment outcomes and side effects, can influence whether a patient decides to accept or refuse treatment. 22 The doctor-patient relationship, the level of trust in one's doctor, and provider attitudes toward the cost-benefit ratio of HCV treatment may also impact a patient's decision to undergo treatment, although only few published studies have explored these relationships.…”

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confidence: 99%