- Title
- A multi method approach to understanding and predicting therapeutic alliance in a dual diagnosis population
- Creator
- Knock, Elizabeth
- Resource Type
- thesis
- Date
- 2012
- Description
- Professional Doctorate - Doctorate of Clinical and Health Psychology
- Description
- Scope: This thesis reviews the significant body of research demonstrating the importance of the therapeutic alliance within psychotherapy, and examines this relationship within the lesser studied area of comorbid substance use and depression treatment. The role of pre-existing client characteristics and within treatment therapist components on alliance development is unclear, both with comorbidity treatment and broader psychotherapy. The role of these factors, as well as their influence on the therapy outcome alongside the alliance, is examined and discussed in light of existing literature. Purpose: The purpose of the current study is to examine factors influencing the therapeutic alliance in treatment for substance abuse and depression from the client perspective. It aims to examine potential pre-treatment client characteristics associated with alliance, and the relationship between alliance and outcome in the presence of these factors in this population. Furthermore, the study aims to gain a deep understanding of the client experience of the therapeutic relationship, and through this an understanding of the impact of ‘in therapy’ factors on alliance, within comorbidity treatment. Methodology: The study employed a mixed methods design within the Depression and Alcohol Integrated and Single focus Intervention (DAISI) study. Quantitative data was collected from participants who completed a 10 week integrated CBT/MI individual treatment addressing their alcohol use and depression (N=75). Baseline predictors of client and therapist rated therapeutic alliance were examined, as well as the influence of alliance on substance use and depression outcome at six month follow-up. Participants were recontacted post follow-up and seven semi-structured interviews were completed and analysed using the qualitative methodology of Interpretative Phenomenological Analysis (IPA). This approach was utilised to reveal a deep understanding of participant’s experiences of the therapeutic relationship within treatment. Results: Of the hypothesised baseline predictors of alliance , severity of alcohol use and depression at baseline were significantly associated with therapist ratings of alliance, while cluster B personality traits and mother’s style of parenting were associated with client ratings of alliance. A significant relationship between alliance and 6-months alcohol use outcome was found, with higher client rated confidence and therapist rated bond associated with significantly lower alcohol use at six months. No such relationship was found for severity of depression at follow-up, with baseline depression the only variable associated with severity of depression at six months. IPA identified four major themes elicited from clients involved in DAISI integrated treatment. ‘Nature of the relationship’ describes the importance to clients of the relationship experienced during treatment; ‘Confidence in therapy’ and ‘Acknowledgment of experience’ address components clients perceived assisted the development of a positive alliance with their therapist, and ‘Meeting unmet needs’ illustrates the importance of a positive therapeutic relationship for this population. Conclusions and implications: Together, all components of this study indicate that both client and therapist factors are relevant to the development of alliance in comorbid alcohol use and depression treatment, especially in terms of predicting 6-month alcohol use outcomes. It is proposed that the therapeutic alliance is particularly important for this comorbid population, stemming in part from client characteristics, which not only have the potential to make the development of alliance more difficult, but also add to the value and significance of the strong alliance relationships for these clients. Quantitative and qualitative results identified these characteristics as being related to interpersonal and social relationship experiences and styles. Of significance is that despite people reporting current, active and hazardous alcohol use problems and current moderate depressive symptomology, engagement in a meaningful therapeutic encounter is possible, as is the formation of a strong and important therapeutic relationship with their treating clinician. Together, this has the potential to meet a number of interpersonal needs for the client with comorbidity and has a positive influence on alcohol use outcomes. This is despite the well documented challenges that working with a comorbid treatment group often presents.
- Subject
- dual diagnosis; therapeutic alliance; psychotherapy; comorbidity; therapeutic relationship; engagement; interpretative phenomenological analysis
- Identifier
- http://hdl.handle.net/1959.13/934252
- Identifier
- uon:11815
- Rights
- Copyright 2012 Elizabeth Knock
- Language
- eng
- Full Text
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