Home > Current

Therapeutic Alliance and Treatment Outcomes Among Treatment Seekers with Behavioral Expressions of Addiction: A Preliminary Study

Ryan Hing-yan Wong （ Tung Wah Group of Hospitals ）

Elda Mei-Lo Chan （ St. John's Cathedral Counseling Service ）

Fung Yee Ching （ Tung Wah Group of Hospitals ）

Vanice W.Y. Chan （ Tung Wah Group of Hospitals ）

Matthew A. Tom （ Cambridge Health Alliance ）

Alessandra B. Grossman

Alexander S. LaRaja

Karen A. Amichia

Howard J. Shaffer

Abstract

Therapeutic alliance (TA) refers to the quality of the working relationship between a therapist and client. Clinicians and researchers have long hypothesized that the TA is an instrumental aspect of psychotherapy (Martin et al., 2000; Del Re et al., 2012). Given the considerable overlap between behavioral and chemical expressions of addiction, and previous TA research with chemical addiction, it is important to consider how TA is associated with those seeking treatment for behavioral expressions of addiction. This study evaluates the impact of TA on addiction treatment outcomes among those seeking care at a treatment center designed to care for a variety of addiction expressions and other mental health disorders. We successfully recruited 346 treatment seekers (i.e., 72.1% of eligible treatment seekers) from the pool of treatment seekers at three clinical addiction service locations. This study advances the field and contributes novel findings by including a diverse group of addiction treatment-seekers. The results provide partial support for the following hypothesis: A more favorable TA from the client’s point of view at intake is associated with reductions of the addictive behavior despite negative consequences at termination. We suggest that clients need to develop, recognize, and maintain a strong TA with their treatment provider early in the treatment process, to maximize the effectiveness of such treatment.

Keywords

addiction; Hong Kong; syndrome model; therapeutic alliance; treatment seekers

Full Text

PDF

References

Ardito, R. B., & Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research. Frontiers in Psychology, 2. https://doi.org/10.3389/fpsyg.2011.00270
Bachelor, A. (2013). Clients' and Therapists' Views of the Therapeutic Alliance: Similarities, Differences and Relationship to Therapy Outcome: Clients' and Therapists' Alliances. Clinical Psychology & Psychotherapy, 20(2), 118-135. https://doi.org/10.1002/cpp.792
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory and Practice, 16(3), 252-260. https://doi.org/10.1037/h0085885
Carroll, K. M., Nich, C., & Rounsaville, B. J. (1997). Contribution of the therapeutic alliance to outcome in active versus control psychotherapies. Journal of Consulting and Clinical Psychology, 65(3), 510-514. https://doi.org/10.1037/0022-006X.65.3.510
Connors, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R., & Donovan, D. M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65(4), 588-598. https://doi.org/10.1037/0022-006X.65.4.588
Del Re, A. C., Flückiger, C., Horvath, A. O., Symonds, D., & Wampold, B. E. (2012). Therapist effects in the therapeutic alliance–outcome relationship: A restricted-maximum likelihood meta-analysis. Clinical Psychology Review, 32(7), 642-649. https://doi.org/10.1016/j.cpr.2012.07.002
Dowling, N. A., & Ćosić, S. (2011). Client Engagement Characteristics Associated with Problem Gambling Treatment Outcomes. International Journal of Mental Health and Addiction, 9(6), 656-671. https://doi.org/10.1007/s11469-010-9298-x
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340. https://doi.org/10.1037/pst0000172
Glazer, S. S., Galanter, M., Megwinoff, O., Dermatis, H., & Keller, D. S. (2003). The role of therapeutic alliance in network therapy: A family and peer support‐based treatment for cocaine abuse. Substance Abuse, 24(2), 93-100. https://doi.org/10.1080/08897070309511537
Hogue, A., Dauber, S., Stambaugh, L. F., Cecero, J. J., & Liddle, H. A. (2006). Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 74(1), 121-129. https://doi.org/10.1037/0022-006X.74.1.121
Horvath, A. O. (2000). The therapeutic relationship: From transference to alliance. Journal of Clinical Psychology, 56(2), 163-173. https://doi.org/10.1002/(SICI)1097-4679(200002)56:2<163::AID-JCLP3>3.0.CO;2-D
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16. https://doi.org/10.1037/a0022186
Kessler, R. C., Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G., & Leaf, P. J. (1996). The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. The American Journal of Orthopsychiatry, 66(1), 17-31.
Mackesy-Amiti, M. E., & Donenberg, G. (2020). Negative affect and emotion dysregulation among people who inject drugs: An ecological momentary assessment study. Psychology of Addictive Behaviors, 34(6), 650-659. https://doi.org/10.1037/adb0000577
Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438-450. https://doi.org/10.1037/0022-006X.68.3.438
McGuire-Snieckus, R., McCabe, R., Catty, J., Hansson, L., & Priebe, S. (2007). A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine, 37(01), 85. https://doi.org/10.1017/S0033291706009299
Meier, P. S., Donmall, M. C., McElduff, P., Barrowclough, C., & Heller, R. F. (2006). The role of the early therapeutic alliance in predicting drug treatment dropout. Drug and Alcohol Dependence, 83(1), 57-64. https://doi.org/10.1016/j.drugalcdep.2005.10.010
Moyers, T. B., Miller, W. R., & Hendrickson, S. M. L. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73(4), 590-598. https://doi.org/10.1037/0022-006X.73.4.590
Parolin, M., Simonelli, A., Cristofalo, P., Sacco, M., Bacciardi, S., Maremmani, A. G. I., Cimino, S., Trumello, C., & Cerniglia, L. (2017). Drug addiction and emotional dysregulation in young adults. Heroin Addiction and Related Clinical Problems, 19(3), 37-48.
Pettorruso, M., Valle, S., Cavic, E., Martinotti, G., di Giannantonio, M., & Grant, J. E. (2020). Problematic Internet use (PIU), personality profiles and emotion dysregulation in a cohort of young adults: trajectories from risky behaviors to addiction. Psychiatry Research, 289, 113036. https://doi.org/10.1016/j.psychres.2020.113036
R Core Team. (2020). R: A Language and Environment for Statistical Computing. In (Version 4.0.0) R Foundation for Statistical Computing. http://www.R-project.org
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton, M. V. (2004). Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology. Harvard Review of Psychiatry, 12(6), 367-374. https://doi.org/10.1080/10673220490905705
Shaffer, H. J., Tom, M. A., Wiley, R. C., Wong, M. F. Y., Chan, E. M. L., Cheng, G. L. F., Lo, C. K. M., Ma, E. K. Y., Wong, R. H. Y., & Lee, M. (2018). Using the Syndrome Model of Addiction: a Preliminary Consideration of Psychological States and Traits. International Journal of Mental Health and Addiction, 16(6), 1373-1393. https://doi.org/10.1007/s11469-018-9952-2
Torrado, M., Bacelar-Nicolau, L., Skryabin, V., Teixeira, M., Eusébio, S., & Ouakinin, S. (2020). Emotional dysregulation features and problem gambling in university students: a pilot study. Journal of Addictive Diseases, 38(4), 550-566. https://doi.org/10.1080/10550887.2020.1800889
Urbanoski, K. A., Kelly, J. F., Hoeppner, B. B., & Slaymaker, V. (2012). The role of therapeutic alliance in substance use disorder treatment for young adults. Journal of Substance Abuse Treatment, 43(3), 344-351. https://doi.org/10.1016/j.jsat.2011.12.013

Copyright © 2024 Ryan Hing-yan Wong, Elda Mei-Lo Chan, Fung Yee Ching, Vanice W.Y. Chan, Matthew A. Tom, Alessandra B. Grossman, Alexander S. LaRaja, Karen A. Amichia, Howard J. Shaffer Creative Commons License Publishing time:2024-09-06
This work is licensed under a Creative Commons Attribution 4.0 International License