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The Role of the Working Alliance in Treatment for Alcohol Problems

Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study’s objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted p...

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Autores principales: Cook, Sarah, Heather, Nick, McCambridge, Jim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Psychological Association 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476608/
https://www.ncbi.nlm.nih.gov/pubmed/25961147
http://dx.doi.org/10.1037/adb0000058
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author Cook, Sarah
Heather, Nick
McCambridge, Jim
author_facet Cook, Sarah
Heather, Nick
McCambridge, Jim
author_sort Cook, Sarah
collection PubMed
description Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study’s objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted posttreatment motivation and then later treatment outcome. Client and therapist perceptions of the working alliance were assessed after the first treatment session using a short form of the Working Alliance Inventory (WAI) among 173 clients taking part in the United Kingdom Alcohol Treatment Trial (UKATT) and randomized to motivational enhancement therapy (MET) or social behavior and network therapy (SBNT) with complete data on all measures of interest. Structural equation models were fitted to identify predictors of WAI scores and investigate the relationships between WAI and measures of drinking during treatment, posttreatment motivation, and successful treatment outcome (abstinent or nonproblem drinker), and measures of drinks per drinking day and nondrinking days, assessed 9 months after the conclusion of treatment. Motivation to change drinking when treatment began was a strong predictor of client—adjusted coefficient = 2.21 (95% confidence interval [CI] [0.36, 4.06]—but not therapist WAI. Client WAI predicted successful treatment outcome—adjusted odds ratios (OR) = 1.09 (95% CI [1.02, 1.17])—and had effects on drinking during treatment, and on posttreatment motivation to change. There was evidence for effect modification by treatment, with strong associations between WAI and posttreatment motivation, and evidence of WAI prediction of treatment outcomes in the MET group, but no evidence of associations for SBNT. Therapist WAI was not strongly associated with treatment outcome (adjusted OR = 1.05; 95% CI [0.99, 1.10]). The working alliance is important to treatment outcomes for alcohol problems, with client evaluation of the alliance strongly related to motivation to change drinking throughout treatment for MET. It was also much more important than therapist-rated alliance in this study.
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spelling pubmed-44766082015-06-24 The Role of the Working Alliance in Treatment for Alcohol Problems Cook, Sarah Heather, Nick McCambridge, Jim Psychol Addict Behav Predictors of Outcomes Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study’s objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted posttreatment motivation and then later treatment outcome. Client and therapist perceptions of the working alliance were assessed after the first treatment session using a short form of the Working Alliance Inventory (WAI) among 173 clients taking part in the United Kingdom Alcohol Treatment Trial (UKATT) and randomized to motivational enhancement therapy (MET) or social behavior and network therapy (SBNT) with complete data on all measures of interest. Structural equation models were fitted to identify predictors of WAI scores and investigate the relationships between WAI and measures of drinking during treatment, posttreatment motivation, and successful treatment outcome (abstinent or nonproblem drinker), and measures of drinks per drinking day and nondrinking days, assessed 9 months after the conclusion of treatment. Motivation to change drinking when treatment began was a strong predictor of client—adjusted coefficient = 2.21 (95% confidence interval [CI] [0.36, 4.06]—but not therapist WAI. Client WAI predicted successful treatment outcome—adjusted odds ratios (OR) = 1.09 (95% CI [1.02, 1.17])—and had effects on drinking during treatment, and on posttreatment motivation to change. There was evidence for effect modification by treatment, with strong associations between WAI and posttreatment motivation, and evidence of WAI prediction of treatment outcomes in the MET group, but no evidence of associations for SBNT. Therapist WAI was not strongly associated with treatment outcome (adjusted OR = 1.05; 95% CI [0.99, 1.10]). The working alliance is important to treatment outcomes for alcohol problems, with client evaluation of the alliance strongly related to motivation to change drinking throughout treatment for MET. It was also much more important than therapist-rated alliance in this study. American Psychological Association 2015-05-11 2015-06 /pmc/articles/PMC4476608/ /pubmed/25961147 http://dx.doi.org/10.1037/adb0000058 Text en © 2015 The Author(s) http://creativecommons.org/licenses/by/3.0/ This article has been published under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Copyright for this article is retained by the author(s). Author(s) grant(s) the American Psychological Association the exclusive right to publish the article and identify itself as the original publisher.
spellingShingle Predictors of Outcomes
Cook, Sarah
Heather, Nick
McCambridge, Jim
The Role of the Working Alliance in Treatment for Alcohol Problems
title The Role of the Working Alliance in Treatment for Alcohol Problems
title_full The Role of the Working Alliance in Treatment for Alcohol Problems
title_fullStr The Role of the Working Alliance in Treatment for Alcohol Problems
title_full_unstemmed The Role of the Working Alliance in Treatment for Alcohol Problems
title_short The Role of the Working Alliance in Treatment for Alcohol Problems
title_sort role of the working alliance in treatment for alcohol problems
topic Predictors of Outcomes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476608/
https://www.ncbi.nlm.nih.gov/pubmed/25961147
http://dx.doi.org/10.1037/adb0000058
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