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Differences in client and therapist views of the working alliance in drug treatment

Meier, P.S. and Donmall, M.C. (2006) Differences in client and therapist views of the working alliance in drug treatment. Journal of Substance Use, 11 (1). pp. 73-80. ISSN 1475-9942


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Background - There is growing evidence that the therapeutic alliance is one of the most consistent predictors of retention and outcomes in drug treatment. Recent psychotherapy research has indicated that there is a lack of agreement between client, therapist and observer ratings of the therapeutic alliance; however, the clinical implications of this lack of consensus have not been explored.

Aims - The aims of the study are to (1) explore the extent to which, in drug treatment, clients and counsellors agree in their perceptions of their alliance, and (2) investigate whether the degree of disagreement between clients and counsellors is related to retention in treatment.

Methods - The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Client and counsellor ratings of the therapeutic alliance (using the WAI-S) were obtained during weeks 1-12. Retention was in this study defined as remaining in treatment for at least 12 weeks.

Results - Client and counsellor ratings of the alliance were only weakly related (correlations ranging from r = 0.07 to 0.42) and tended to become more dissimilar over the first 12 weeks in treatment. However, whether or not clients and counsellors agreed on the quality of their relationship did not influence whether clients were retained in treatment.

Conclusions - The low consensus between client and counsellor views of the alliance found in this and other studies highlights the need for drug counsellors to attend closely to their clients' perceptions of the alliance and to seek regular feedback from clients regarding their feelings about their therapeutic relationship.

Item Type: Article
Copyright, Publisher and Additional Information: © 2006 Taylor & Francis. This is an author produced version of a paper published in Journal of Substance Use. Uploaded in accordance with the publisher's self-archiving policy.
Keywords: therapeutic alliance, drug treatment, retention
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > Section of Public Health (Sheffield)
Depositing User: Repository Officer
Date Deposited: 18 Jun 2009 14:14
Last Modified: 08 Feb 2013 16:58
Published Version: http://dx.doi.org/10.1080/14659890500137004
Status: Published
Publisher: Taylor & Francis
Refereed: Yes
Identification Number: 10.1080/14659890500137004
URI: http://eprints.whiterose.ac.uk/id/eprint/8716

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