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

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

The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature

Background: In the past two decades, a number of studies investigating the role of the therapeutic alliance in drug treatment have been published and it is timely that their findings are brought together in a comprehensive review. Aims: This paper has two principal aims: (1) to assess the degree to which the relationship between drug user and counsellor predicts treatment outcome and (2) to examine critically the evidence on determinants of the quality of the alliance. Methods: Peer‐reviewed research located through the literature databases Medline, PsycInfo and Ovid Full Text Mental Health Journals using predefined search‐terms and published in the past 20 years is considered. Further papers were identified from the bibliographies of relevant publications. Findings: A key finding is that the early therapeutic alliance appears to be a consistent predictor of engagement and retention in drug treatment. With regard to other treatment outcomes, the early alliance appears to influence early improvements during treatment, but it is an inconsistent predictor of post‐treatment outcomes. There is relatively little research on the determinants of the alliance. In studies that are available, clients’ demographic or diagnostic pre‐treatment characteristics did not appear to predict the therapeutic alliance, whereas modest but consistent relationships were reported for motivation, treatment readiness and positive previous treatment experiences. Conclusions: The therapeutic alliance plays an important role in predicting drug treatment process outcomes, but too little is known about what determines the quality of the relationship between drug users and counsellors

Necip Mahfuz'un et-Tarik Adlı Romanının İncelenmesi

Background - Counselling is one of the most common treatment options in drug services, and recent research has convincingly demonstrated its effectiveness if certain quality parameters regarding intensity and qualifications of those providing it are observed. However, there is a remarkable paucity of literature on the nature of counselling provision in UK drug treatment. Aims - To describe the extent and nature of counselling provision in UK drug treatment services. Method - A national survey of specialist drug services in England and Wales was carried out, and information was obtained from 326 services. Results - Levels of counselling provision were very similar in nonstatutory, community-based, residential day care and statutory, community-based services (around 90%), with slightly lower levels in inpatient services (78%, difference not significant). In the majority of services (74%), individual sessions were provided by drug workers without counselling accreditation. In 32% of agencies, counselling was provided only by drug workers, whereas 36% of agencies employed both drug workers and accredited counsellors. In 17% of agencies, sessions were run by accredited counsellors only. Volunteers without formal training provided one-to-one sessions in 27% of agencies, mostly in agencies also employing counsellors and drug workers. Most agencies (66%) operated a schedule of weekly sessions; 12% of agencies offered fortnightly or less frequent sessions, whereas 15% of agencies offered several sessions a week. More than three-quarters of all sessions were scheduled to last between 50 and 60 minutes. Conclusion - Typically, counselling is provided on a weekly to fortnightly basis by drug workers without formal counselling qualifications. In-depth research is needed to examine whether and how sessions provided by drug workers differ from sessions provided by counsellors, as past research has only demonstrated the effectiveness of counselling in studies using highly trained counselling staff

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

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 1-3) 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 well-being, 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. © 2005 Elsevier Ireland Ltd. All rights reserved

How well do trends in incidence of heroin use reflect hypothesised trends in prevalence of problem drug use in the North West of England?

This study investigates whether hypotheses about trends in the prevalence of problem drug use (PDU), prompted by capture--recapture based age-specific prevalence estimates, are corroborated by estimates of trends in incidence. Lag correction techniques were used to provide incidence estimates adjusted for the time-lag between onset of drug use and its first recorded treatment for heroin users seeking treatment in three areas of North West England between 1986 and 2000 (n=4142). The incidence trends indicated geographical variation in the progress of heroin ‘epidemics’ in the areas studied and corroborated previously estimated prevalence rates that suggested PDU has passed its peak and is declining in some areas, but continues to increase in others. The lag correction method is capable of producing estimates that will improve our understanding of changes in the size and composition of the population targeted for drug misuse treatment and may provide a basis on which to forecast the direction of future trends