How Does the Therapeutic Alliance Help Determine the Outcome of Alcohol Treatment?
The initiation of a therapeutic alliance depends on several important factors, including the ability of a therapist and client/patient to form a rapport, a common understanding between the therapist and his or her client/patient about the approach used during treatment and a shared understanding between the therapist and his or her client/patient about the ultimate purpose of treatment. As a rule, therapists promote the formation of a strong alliance by doing such things as treating their clients/patients with respect and friendliness, being attentive to ongoing changes in the dynamic of each therapy session, behaving in a manner that promotes trust and avoiding a judgmental, confrontational, inflexible, detached or disinterested demeanor. Once a therapeutic alliance is established, its maintenance depends on factors such as the ability to sense potentially disruptive stresses in the alliance, as well as the ability to overcome these stresses and place them in the context of the larger relationship between the therapist and client/patient.
Therapies Used During Alcohol Treatment
Along with medication, therapy commonly plays an important role in successful alcohol treatment. Specific approaches used include cognitive behavioral therapy, a technique designed to help program participants recognize and change their dysfunctional reactions to certain situations; 12-step support groups, which rely on a progressive series of life-altering actions (i.e., the 12 steps) and mutually maintained alcohol abstinence; and motivational enhancement therapy, which helps program participants identify and overcome any internal conflicts they have about stopping drinking and committing fully to the recovery process. Some programs augment these approaches with Internet-based treatments or other modern-day techniques that expand the availability of therapists and allow clients/patients to receive the care they need even if they live in remote areas or otherwise lack sufficient access to in-person treatment resources.
Change in Alliance Impacts Alcohol Treatment Outcomes
In the study published in Substance Abuse, researchers from the University of Texas at Austin, the University of Florida and Sam Houston State University used information from a previous undertaking called Project MATCH to determine if changes in the therapeutic alliance have an impact on the outcomes for people participating in alcohol treatment programs. The researchers chose to initiate their study, in part, because previously completed efforts in their field had largely not touched on this issue. Two large groups of patients/clients were included in the study: 952 individuals actively receiving outpatient treatment and 774 individuals involved in an aftercare program after completing primary involvement in alcohol treatment. Roughly equal numbers of people from both groups received cognitive behavioral therapy, assistance from a 12-step program or motivational enhancement therapy.
After reviewing the treatment outcomes for the outpatient and aftercare participants receiving each type of therapy, the researchers came to a couple of important conclusions. First, the therapeutic alliance strengthened over time for those individuals participating in cognitive behavioral therapy or a 12-step program, but did not strengthen for those individuals participating in motivational enhancement therapy. In addition, those clients/patients who experienced a deepening of the alliance with their therapists substantially reduced the number of occasions on which they consumed alcohol.
Significance and Considerations
The authors of the study published in Substance Abuse found that, no matter what specific type of therapy they receive, people going through alcohol treatment typically experience the largest reductions in their alcohol intake during the initial and middle stages of their program involvement. After that timeframe, most people avoid alcohol somewhat less successfully, both while still actively involved in primary treatment and while participating in aftercare. Critically, the study’s authors also found that the strength of the therapeutic alliance does not appear to directly determine the overall outcomes of participation in cognitive behavioral therapy, 12-step programs or motivational enhancement therapy. Instead, the impact of a deepening alliance appears only to be specifically associated with a reduction in the number of times a person in treatment or aftercare takes a drink.