Examining the role of therapeutic alliance in patient recovery

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The quality of the relationship between patient and therapist is known as therapeutic alliance. Therapeutic alliance describes the level of trust and engagement between a patient and members of his or her treatment team. Research on therapeutic alliance examines the bond between patient and therapist, the level of agreement between both parties on treatment goals and therapeutic tasks, and how these factors influence treatment success.

Therapeutic alliance is specifically important to the recovery process among those seeking treatment for addiction and mental illness. Research has shown that the development of a strong therapeutic relationship predicts better treatment outcomes.

As part of HRI’s outcome monitoring system, our research team has been measuring therapeutic alliance in patients of the Addiction Medicine Service at Homewood Health Centre for more than two years.

Prior to discharge, participants are asked to rate six statements relating to mutual respect and mutual agreement on goals and therapeutic tasks. Overall, ratings of therapeutic alliance were strong among participants. When contacted 30 days after discharge, those who rated their therapeutic alliance the strongest were significantly more likely to report high levels of confidence (also referred to as “self-efficacy”) in their ability to work on their recovery. In addition, those who reported higher ratings of therapeutic alliance also reported higher levels of self-perceived mental health and physical health at one month post-discharge.

What does this mean?

Strong therapeutic alliance is linked to higher levels of self-efficacy, and research has shown that self-efficacy is an important factor in achieving enduring behaviour change, such as reduced substance use. So these early findings suggest that a strong therapeutic alliance helps to set people up for success.

Where will this research go?

In November 2017, HRI will share detailed findings of our research on therapeutic alliance at the Issues of Substance Conference, hosted by the Canadian Centre on Substance Use and Addiction, in Calgary, Alberta.

In future analyses, HRI will investigate whether participants’ ratings of therapeutic alliance at discharge are related to ongoing recovery at later time points after discharge. We also plan to monitor therapeutic alliance during treatment so that steps can be taken to ensure that this alliance is as strong as possible, as a way to improve care and outcomes.