Relating counselor attributes to client engagement in England

Abstract

Client functioning and treatment engagement were examined in relation to staff attributes and organizational climate across a diverse sample of drug treatment and outreach programs in England. Self-rating assessments were obtained from 1,539 clients and 439 counselors representing 44 programs, and results were interpreted using comparable data from studies of treatment programs in the United States. Client scores on treatment participation and counseling rapport in England were directly related to their higher levels of motivation and psychosocial functioning, as well as to staff ratings of professional attributes and program atmosphere. By linking records from English clients with their counselors in each program, findings also indicate these relationships are rooted in the personal interactions between clients and their counselor. Standardized assessments of treatment structure, process, and performance used across therapeutic settings and national boundaries show there is generalizability in the pattern of clinical dynamics, including the relationships between organizational functioning and quality of services.

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

“…Anxiety Simpson et al, 2009), avoidance , hopelessness , hostility, risk-taking Simpson et al, 2009) and medical comorbidity (Bowersox et al, 2013) were all related to decreased participation or involvement. This indicates that clients' problems bring them to treatment but tend to have an adverse effect on their abilities to become involved in treatment.…”

“…Greener et al (2007), Simpson, Joe and Rowan-Szal (2007), Simpson et al (2009) and employed the Client Evaluation of Self and Treatment (CEST: Joe et al, 2002), McMurran et al (2013) employed the Treatment Engagement Rating Scale (TER: Drieschner & Boomsma, 2008b) and Tait et al (2003) employed the Treatment Engagement Scale (TES: Tait et al, 2003). These three engagement measures are now discussed in turn.…”

“…Motivation is particularly likely to change as a function of treatment and how it relates to participation, which may explain the mixed findings. Treatment readiness (Joe et al, 1999;Simpson, Joe, Knight, Rowan-Szal, & Gray, 2012;Simpson et al, 2009) and higher levels of integrated motivation (Klag et al, 2010) were positively associated with involvement, but so was legal pressure (Joe et al, 1999) and higher levels of external motivation (Klag et al, 2010). Amotivation (client perceives no control over behavior) was not related to participation (Klag et al, 2010), indicating that this treatment standpoint is not necessarily detrimental to clients' involvement.…”

“…Amotivation (client perceives no control over behavior) was not related to participation (Klag et al, 2010), indicating that this treatment standpoint is not necessarily detrimental to clients' involvement. The mixed findings may reflect the assessments of these factors, particularly motivation, at only one, varying time point during the course of treatment Joe et al, 1999;Klag et al, 2010;Simpson et al, 2009), but they also reflect that factors such as motivation should not be regarded as a fixed trait, but a dynamic treatment target to enhance participation.…”

“…It is likely that the symptoms of particular dysfunctions that are inherently antisocial (e.g. hostility, aggression) naturally pose a challenge to the development of the therapeutic relationship, whereas it is easier among clients with greater capacities to address their problems, such as social compliance , treatment compliance , and confidence (Kuutmann & Hilsenroth, 2012;Simpson et al, 2009). The findings indicate that motivated, pro-treatment clients are easier to work with but these clients are also likely, by virtue of their higher capacities to address their problems, to provide higher ratings of the therapeutic alliance.…”