Examining the Therapeutic Alliance: A Case Study At a Drug Rehabilitation Facility
DOI:
https://doi.org/10.61841/kea81y85Keywords:
Therapeutic Alliance, Spirituality, Behavior ChangeAbstract
An enhanced understanding of therapeutic alliance in drug treatment settings as a peer support community facilitates recovering counselors (RC) and clients in the passage of recovery. The current study explored the therapeutic alliance between recovering counselors (RC) and their clients in a non-governmental drug treatment and rehabilitation center. It aims to explore the therapeutic alliance of recovering counselors—client relationships and interaction that influence the recovering journey. In this study, recovering counselor (RC) refers to experienced and qualified counselors who have completed a Therapeutic Community (TC) program. An in-depth case study was conducted involving 3 pairs of counselors and clients who volunteered to participate in the study. The data were collected through 16 in–depth interview sessions, observations, and personal reflections. The qualitative data suggest that the experience of therapeutic alliance was represented by three major themes: 1) therapeutic relationship, 2) spirituality, and 3) successful recovery and behavior change. Each pair of counselors-clients reflects a different level of therapeutic experience as the clients make progress from primary treatment to re-entry phases. The findings help to enhance the knowledge on how a therapeutic alliance helps both counselors and clients to flourish as progressive individuals. This study suggested that recovering counselors become a role model for clients to sustain their recovery and motivation for behavior change. However, further investigations are needed to support the current findings. Implications for future study are also discussed.
Downloads
References
[1] Alexandre B. Laudet, Keith M & William L. White (2006). The Role of Social Supports, Spirituality,
Religiousness, Life Meaning and Affiliation with 12-Step Fellowships in Quality of Life Satisfaction
Among Individuals in Recovery from Alcohol and Drug Problems. Alcohol Treat Q.2006; 24(1-2): 33–73.
[2] Amat, M. I. (2013). Recovery journeys of counselors and clients: A case study of the therapeutic alliance in
a drug treatment and rehabilitation centre in Malaysia (Order No. 3563468). Available from ProQuest
Dissertations & Theses Global. (1399993761).
[3] Appelbaum, A (1972). A critical re-examination of the concept of "motivation for change" in
psychoanalytic treatment. International Journal of Psychoanalysis. 1972; 53:51-59.
[4] Barrazzone, N., Cavanagh, K., & Richards, D. A. (2012). Computerized cognitive behavioural therapy
and the therapeutic alliance: A qualitative enquiry. British Journal of Clinical Psychology, 51(4), 396–417.
[5] Bettmann & Jasperson (2009), Adolescents in Residential and Inpatient Treatment: A Review of the
Outcome Literature. Child and Youth Care Forum 38(4):161-183.
[6] Bordin, E. S. (1994). Theory and research on the therapeutic working alliance: New directions. In A. O.
Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp.13–37). New
York: John Wiley & Sons.
[7] Carson, D., Gilmore, A., Perry, C. & Gronhaug, K., (2001). Qualitative Marketing Research. London: Sage
Publications.
[8] Corsini, R. J. & Wedding, D. (2011). Current Psychotherapies. (5th ed.). Belmont, CA: Brooks/Cole
Cengage Learning.
[9] Colson D.B, Carol.C, Thomas M, Flynn O, Patricia S.H, Mary M.P, Lolafaye C (1991), Perceived
Treatment Difficulty and Therapeutic Alliance on An Adolescent Psychiatric Hospital Unit. American
Journal of Orthopsychiatry Mental Health & Social Justice.
[10] Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation
and interpersonal problems as predictors of functional impairment in survivors of childhood abuse.
Behavior Therapy, 36, 119-124.
[11] Cloitre, M., Stovall-McClough, K. C., Miranda, R., & Chemtob, C. M. (2004). Therapeutic alliance,
negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder.
Journal of Consulting and Clinical Psychology, 12, 411-416.
[12] Connors G, Tonigan S, Miller W. A (1996). Measure of Religious Background and Behavior for use in
behavior change research. Psychology of Addictive Behaviors; 10:90–96.
[13] Dermatis, H., & Galanter, M. (2016). The Role of Twelve-Step-Related Spirituality in Addiction
Recovery. Journal of Religion and Health, 55(2), 510-521.
[14] Ellison C. Religious involvement and subjective well-being (1991). Journal Health Social Behavior;
32:80–99.
[15] Etikan. I, Sulaiman & Rukayya.S.A (2016). Comparison of Convenience Sampling and Purposive
Sampling. American Journal of Theoretical and Applied Statistics; 5(1): 1-4.
[16] Fontana, A., & Frey, J. H. (1994). Interviewing. The art of science. In N. K. Denzin & Y. S. Lincoln (Eds.),
Handbook of qualitative research (pp. 361–376). Thousand Oaks: Sage.
[17] Giordano, A. L., Prosek, E. A., Daly, C. M., Holm, J. M., Ramsey, Z. B., Abernathy, M. R., & Sender,
K. M. (2015). Exploring the Relationship Between Religious Coping and Spirituality Among Three
Types of Collegiate Substance Abuse. Journal of Counseling & Development, 93(1), 70-79.
[18] Ham, C. C., LeMasson, K. S., & Hayes, J. A. (2013). The Use of Self-Disclosure: Lived Experiences of
Recovering Substance Abuse Counselors. Alcoholism Treatment Quarterly, 31(3), 348-374.
[19] Ham, C. C. (2009). The wounded healer: A phenomenological investigation of the recovering substance
abuse counselor (Order No. 3380910).
[20] Horvath, A. O., & Symonds, D. (1991). Relation between working alliance and outcome: A meta-analysis.
Journal of Counseling Psychology, 38, 139-149.
[21] J.A. Maxwell (2005). Qualitative Research Design: An Interactive Approach. 2nd ed. (Sage Publications,
Thousand Oaks.
[22] Jennifer E.B, Danica K.K, Rachel.D.C, George W.J & Patrick M.F (2015). Effectiveness of the Treatment
Readiness and Induction Program for Increasing Adolescent Motivation for Change. 50: 38 – 49.
[23] Jones, ML (2007). Using software to analyze qualitative data. Malaysian Journal of Qualitative Research,
1(1), 64-76.
[24] Krupnick JL, Sotsky SM, Simmens S, Moyer J, Elkin I, Watkins J, Pilkonis PA (1996). The role of the
therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of
Mental Health Treatment of Depression Collaborative Research Program. Journal Consulting Clinical
Psychology. 64 (3):532-9.
[25] Kurtz, E., & White, W. L. (2015). Recovery Spirituality. Religions, 6(1), 58-81.
[26] Leibert, T.W., Smith, J.B., & Agaskar, V.R. (2011). Relationship between the Working Alliance and Social
Supports on Counseling Outcome. Journal of Clinical Psychology, 67(7), 709-719.
[27] Margolis R, Kilpatrick A, Mooney B. A retrospective look at long-term adolescent recover: Clinicians talk
to researchers. Journal of Psychoactive Drugs. 2000;32:117–125.
[28] McPhail, J. (2003). MGT8400 Research Methodology Study Book. Toowoomba, Australia: USQ,
December.
[29] Merriam, S. B. (2009). Qualitative research: A guide to design and implementation. San Francisco, CA:
Jossey-Bass.
[30] Merriam, S. B. (2009). Qualitative research: A guide to design and implementation. San Francisco, CA:
Jossey-Bass.
[31] Meier, P. S., Barrowclough, C., & Donmall, M. C. (2005). The role of the therapeutic alliance in the
treatment of substance misuse: A critical review of the literature. Addiction, 100(3), 304–316.
[32] Metcalf, B. D. (2002). Traditionalist islamic activism: Deoband, tabligh, and talibs. Netherlands: Leiden
ISIM (International Institute for the Study of Islam in the Modern World).
[33] Miles, M. & M. Huberman. (1994). Qualitative data. Thousand Oaks. Sage Publications.
[34] Miller W. R (1999). Enhancing Motivation for Change in Substance Abuse Treatment. Center for
Substance Abuse Treatment (U.S) : DIANE Publishing.
[35] Miller W. R & Thoresen C (2003). Spirituality, religion and health: An emerging research field. American
Psychologist. 2003; 58:24–35.
[36] Miller W. R. and Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive
behavior. New York: Guilford Press.
[37] Miller W. R, Del Boca FK (1994). Measurement of drinking behavior using the Form 90 family of
instruments. Journal of Studies on Alcohol Supplement. ; 12:112–118.
[38] Miller W. R. Motivation for treatment (1985): A review with special emphasis on
alcoholism. Psychological Bulletin; 98(1):84–107.
[39] Morjaria A, Orford J. The role of religion and spirituality in recovery from drink problems: A qualitative
study of Alcoholics Anonymous members and South Asian men. Addiction Research &
Theory. 2002;10:225–256.
[40] Munder, T., Wilmers, F., Leonhart, R., Linster, H. W., Barth, J. (2010). Working alliance inventory-short
revised (WAI-SR): Psychometric properties in outpatients and inpatients. Clinical Psychology and
Psychotherapy, 17, 231-239.
[41] Mustain, J. R., & Helminiak, D. A. (2015). Understanding spirituality in recovery from addiction:
Reintegrating the psyche to release the human spirit. Addiction Research & Theory, 23(5), 364-371.
[42] Orlinsky, Ronnestad, & Willutzski (2004). Fifty years of psychotherapy process-outcome research:
Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and
behavior change (5th ed., pp. 307–389). New York, NY: John Wiley & Sons.
[43] Oene, G. H., Schippers, G. M., De Jong, C., & Schrijvers, G (2001). Retention in substance dependence
treatment: The relevance of in-treatment factors. Journal of Substance Abuse Treatment, 20, 253-261.
[44] Perfas, F. B. (2003). Therapeutic community a practice guide. Lincoln, NE: iUniverse Inc.
[45] Perfas, F. B. (2012). Deconstructing the therapeutic community: A practice guide for addiction
professionals. Red Hook, NY: Hexagram Publishing.
[46] Perry, C. (2001). Case research in marketing. The Marketing Review, 1: 303–323.
[47] Prochaska, J. O., DiClemente, C. C. (1983). Stage and process of self–change in smoking: Towards an
integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.
[48] Rogers, C. (1951). Client-centered therapy: Its current practice, implications and theory. London:Constable.
[49] Romney, A. K., Weller, S. C., & Batchelder, W. H. (1986). Culture and consensus: A theory of culture and
informant accuracy. American Anthropologist, 88(2), 313–338.
[50] Safran, J. D., Muran, J. C., Samstag, L. W., & Stevens, C. (2001). Repairing alliance ruptures.
Psychotherapy: Theory, Research, Practice, Training, 38(4), 406–412.
[51] Stake, R. E. (2010). Qualitative research: Studying how things work. New York: Guilford Press.
[52] Tasca, G. A., Compare, A., Zarbo, C., & Brugnera, A. (2016). Therapeutic alliance and binge
eatingoutcomes in a group therapy context. Journal of Counseling Psychology, 63(4), 443–451.
[53] Taylor, P. J., Rietzschel, J., Danquah, A., & Berry, K. (2015). The role of attachment style, attachment to
therapist, and working alliance in response to psychological therapy. Psychology and Psychotherapy, 88(3),
240-253.
[54] Urbanoski, K. A., Kelly, J. F., Hoeppner, B. B., & Slaymaker, V. (2012). The role of therapeutic alliance
in substance use disorder treatment for young adults. Journal of Substance Abuse Treatment, 43(3), 344–
351.
[55] Wang, C. C., Cash, J. L. & Powers, L.S. (2000). Who knows the streets as well as homeless? Promoting
personal and community action through photovoice. Health Promotion Practice, 1, 81-89.
[56] Watts, J. R., O'Sullivan, D., & Chatters, S. J. (2018). Strengthening the working alliance for clients with
substance use disorders and child maltreatment histories. Journal of Mental Health Counseling, 40(1), 58-
74.
[57] Yin, R., (1994). Case study research: Design and methods (2nd ed.). Beverly Hills, CA: Sage Publishing.
[58] Zaidah Zainal (2007). Case study as a research method. Jurnal Kemanusiaan bil 9.
[59] Zikmund, W.G. (2000). Business Research Methods, 6th Ed., New York: Dryden Press.
[60] Zilcha-Mano, S., Muran, J. C., Hungr, C., Eubanks, C. F., Safran, J. D., & Winston, A. (2016). The
relationship between alliance and outcome: Analysis of a two-person perspective on alliance and session
outcome. Journal of Consulting and Clinical Psychology, 84(6), 484–496.
Downloads
Published
Issue
Section
License
Copyright (c) 2020 AUTHOR

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.