The Role of Therapeutic Alliance in Treatment for People with Mild to Moderate Alcohol Dependence

  • Deirdre F. RichardsonEmail author
  • Simon J. Adamson
  • Daryle E. A. Deering


In an exploratory study of Therapeutic Alliance (TA) in brief outpatient treatment for alcohol dependence the relationship was investigated between TA and treatment outcome (measured at 6 weeks and 6 months) for 69 alcohol dependent clients participating in a randomised control trial between Motivational Enhancement Therapy and Non Directive Reflective Listening. TA was significantly higher for clients who attended all four sessions. The correlation between TA and change in per cent days abstinent (PDA) between baseline and 6 weeks approached significance. TA was significantly correlated with the Alcohol Problem Questionnaire (APQ) at 6 months and with change in APQ scores between baseline and 6 months. These relationships remained significant when treatment assignment was controlled for. Whilst there was a trend towards a relationship between TA and change in PDA between baseline and 6 months, this trend no longer remained when both treatment assignment and early change in drinking levels were controlled for. Therapeutic alliance may be a useful additional maker to predict outcome, but early treatment response appears to be a better predictor.


Alcohol dependence Therapeutic alliance Treatment outcome Engagement Treatment assignment 



The authors would like to thank all clients who took part in the study. Thanks also to Professor Chris Frampton (University of Otago) for statistical advice. Funding was provided by the Health Research Council grant 96/328 and by the Alcohol Advisory Council of New Zealand. Ethical approval was granted by the Canterbury Regional Ethics Committee.


  1. Adamson, S. J., Sellman, J. D., & Frampton, C. M. A. (2009). Patient predictors of alcohol treatment outcome: A systematic review. Journal of Substance Abuse Treatment, 75–86.Google Scholar
  2. APA. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  3. Barber, J. P., Luborsky, L., Gallop, R., Crits-Christoph, P., Frank, A., Weiss, R. D., et al. (2001). Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse collaborative cocaine treatment study. Journal of Consulting and Clinical Psychology, 69, 119–124.PubMedCrossRefGoogle Scholar
  4. Belding, M. A., Iguchi, M. Y., Morral, A. R., & McLellan, A. T. (1997). Assessing the helping alliance and its impact in the treatment of opiate dependence. Drug and Alcohol Dependence, 48, 51–59.PubMedCrossRefGoogle Scholar
  5. Bryman, A. (2004). Social research methods (2nd ed.). Oxford: Oxford University Press.Google Scholar
  6. Cloninger, C. R., Sigvardsson, S., & Bohman, M. (1996). Type I and type II alcoholism: An update. Alcohol Health and Research World, 20(1), 18–23.Google Scholar
  7. Connors, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R., & Donovan, D. M. (1997). Therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65(4), 588–598.PubMedCrossRefGoogle Scholar
  8. Crits-Christoph, P., Gallop, R., Temes, C. M., Woody, G., Ball, S. A., Martine, S., et al. (2009). The alliance in motivational enhancement therapy and counselling as usual for substance use problems. Journal of Consulting and Clinical Psychology, 77(6), 1125–1135.PubMedCrossRefGoogle Scholar
  9. Drummond, D. C. (1990). The relationship between alcohol dependence and alcohol-related problems in a clinical population. British Journal of Addiction, 85, 357–366.PubMedCrossRefGoogle Scholar
  10. Dundon, W. D., Pettinati, H. M., Lynch, K. G., Xie, H., Varillo, K. M., Makadon, C., et al. (2008). The therapeutic alliance in medical-based interventions impacts outcome in treating alcohol dependence. Drug and Alcohol Dependence, 95, 230–236.PubMedCrossRefGoogle Scholar
  11. Fenton, L. R., Cecero, J. J., Nich, C., Frankforter, T. L., & Carroll, K. M. (2001). Perspective is everything: The predictive validity of six working alliance instruments. Journal of Psychotherapy Practice and Research, 10, 262–268.PubMedGoogle Scholar
  12. Hovarth, A. O., & Greenberg, L. S. (1986). The development of the working alliance inventory. In L. S. Greenberg & W. M. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 529–556). New York: Guildford.Google Scholar
  13. Hovarth, A. O., & Luborsky, L. (1993). The role of therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561–573.CrossRefGoogle Scholar
  14. Hovarth, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcomes in psychotherapy: A meta analysis. Journal of Counselling Psychology, 38, 139–149.CrossRefGoogle Scholar
  15. Hser, Y., Grella, C. E., Hsieh, S., Anglin, M. D., & Brown, B. S. (1999). Prior treatment experience related to process and outcomes in DATOS. Drug and Alcohol Dependence, 57, 137–150.PubMedCrossRefGoogle Scholar
  16. Ilgen, M., & Moos, R. (2005). Deterioration following alcohol-use disorder treatment in Project MATCH. Journal of Studies on Alcohol, 66, 517–525.PubMedGoogle Scholar
  17. Ilgen, M., McKellar, J., Moos, R., & Finney, J. (2006). Therapeutic alliance and the relationship between motivation and treatment outcomes in patients with alcohol use disorder. Journal of Substance Abuse Treatment, 31, 157–162.PubMedCrossRefGoogle Scholar
  18. Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcomes and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.PubMedCrossRefGoogle Scholar
  19. McCabe, R., & Priebe, S. (2003). Are therapeutic relationships in psychiatry explained by patients' symptoms? Factors influencing patient ratings. European Psychiatry, 18, 220–225.PubMedCrossRefGoogle Scholar
  20. Meier, P. S., Barrowclough, C., & Donmall, M. C. (2005a). The role of the therapeutic alliance in the treatment of substance misuse: A critical review of the literature. Addiction, 100, 304–316.PubMedCrossRefGoogle Scholar
  21. Meier, P. S., Donmall, M. C., Barrowclough, C., McElduff, P., & Heller, R. F. (2005b). Predicting the early therapeutic alliance in the treatment of drug misuse. Addiction, 100, 500–511.PubMedCrossRefGoogle Scholar
  22. Najavits, L. M., & Weiss, R. D. (1994). Variations in therapist effectiveness in the treatment of patients with substance use disorders: An empirical review. Addiction, 89, 679–688.PubMedCrossRefGoogle Scholar
  23. Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 270–376). New York: John Wiley & Sons.Google Scholar
  24. Paton-Simpson, G., & MacKinnon, S. (1999). Evaluation of the Leeds Dependence Questionnaire (LDQ) for New Zealand. Research monograph series: No10. Wellington: Alcohol Advisory Council of New Zealand.Google Scholar
  25. Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment outcomes. Journal of Studies on Alcohol, 58, 7–29.Google Scholar
  26. Raistrick, D., Bradshaw, J., Tober, G., Weiner, J., Allison, J., & Healey, C. (1994). Development of the Leeds Dependence Questionnaire (LDQ): A questionnaire to measure alcohol and opiate dependence in the context of a treatment evaluation package. Addiction, 89, 563–572.PubMedCrossRefGoogle Scholar
  27. Raytek, H. S., McCrady, B. S., Epstein, E. E., & Hirsch, L. S. (1999). Therapeutic alliance and the retention of couples in conjoint alcoholism treatment. Addictive Behaviors, 24, 317–330.PubMedCrossRefGoogle Scholar
  28. Sellman, J. D., Sullivan, P. F., Dore, G. M., Adamson, S. J., & MacEwan, I. (2001). A randomised control trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence. Journal of Studies on Alcohol, 62, 389–396.PubMedGoogle Scholar
  29. Sellman, J. D., MacEwan, I., Deering, D. E. A., & Adamson, S. (2007). A comparison of motivational interviewing with non-directive counselling. In G. Tober & D. Raistrick (Eds.), Motivational dialogue: Preparing addiction professionals for motivational interviewing practice (pp. 137–150). New York: Routledge.Google Scholar
  30. Sobell, L. C., & Sobell, M. B. (1992). Timeline followback: A technique for assessing self reported alcohol consumption. In R. Z. Litten & J. P. Allen (Eds.), Measuring alcohol consumption (pp. 41–72). New Jersey: Human Press Inc.CrossRefGoogle Scholar
  31. Tunis, S. L., Delucchi, K. L., Schwartz, K., Banys, P., & Sees, K. L. (1995). The relationship of counselor and peer alliance to drug use and HIV risk behaviours in a six-month methadone detoxification program. Addictive Behaviors, 20, 395–405.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Deirdre F. Richardson
    • 1
    • 2
    Email author
  • Simon J. Adamson
    • 2
  • Daryle E. A. Deering
    • 2
  1. 1.Health ServicesWellington Institute of TechnologyChristchurchNew Zealand
  2. 2.National Addiction Centre, Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand

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