The influence of the therapeutic relationship in treatment for alcohol dependency.

The substance abuse field has been slow to embrace research into the impact of the therapeutic relationship on treatment outcome. Limited previous research has demonstrated that therapist factors such as unconditional regard and empathy are associated strongly with treatment outcome. This study examined the relationships between client perception of the therapist and client characteristics; client response to out-patient relapse prevention treatment; and client outcome 3 months following treatment for alcohol dependence. One hundred and sixty-one male clients of a 3-week relapse prevention programme participated in the research, completing questionnaires assessing their perception of therapist regard, empathy, congruence, attractiveness, expertness and trustworthiness. Treatment outcome was measured at the conclusion of treatment, and 3 months post-treatment. Clients who were more anxious and those with poorer cognitive functioning appeared to perceive therapists as showing less unconditional regard, empathy and congruence. Self-efficacy and coping skills acquisition measured at the end of treatment correlated significantly with clients' perceptions of the therapist as empathic, congruent and displaying high regard for them. Treatment outcome at 3 months was associated significantly with degree of perceived therapist expertness and empathy. These relationships held when cognitive functioning and skills acquisition were controlled for. Self-efficacy moderated the relationships between regard and empathy and outcome, but not perceived therapist expertness. A lower than desirable follow-up rate limits the generalizability of the findings. The quality of the therapeutic relationship as perceived by clients appears to be associated with client characteristics, response to treatment and treatment outcome.