Predicting the therapeutic alliance in alcoholism treatment

Objective: Prediction of the therapeutic alliance in alcoholism treatment ( as rated by the client and by the therapist) was examined in light: of a ra nge of potentially relevant factors, including client demographics, drinkin g history, current drinking, current psychosocial functioning and therapist demographics. Method: The data were gathered in Project MATCH. The present analyses were based on data from 707 outpatients and 480 aftercare clients assigned to one of the three Project MATCH treatments. Potential predictor variables were evaluated by first examining bivariate linear relationships between the variables and ratings of the alliance, and then entering block s of these predictors into multiple linear regression equations with allian ce ratings as the dependent variables. All analysis incorporated adjustment s for the nonindependence of ratings pertaining to clients seen by the same therapist. Results: In simple regressions evaluating bivariate relationshi ps, outpatients' ratings of the alliance were positively predicted by clien t age, motivational readiness to change, socialization, level of perceived social support and therapist age, and were negatively predicted by client e ducational level, level of depression, and meaning seeking. Therapist ratin gs in the outpatient sample were positively predicted by the client being f emale and by level of overall alcohol involvement, severity of alcohol depe ndence, negative consequences of alcohol use, and readiness to change. Amon g aftercare clients, ratings of the alliance were positively predicted by r eadiness to change, socialization and social support, and were negatively p redicted by level of depression. Therapist ratings of the alliance in the a ftercare sample were positively predicted by me client being female and the rapist educational level, and were negatively predicted by pretreatment dri nks per drinking day. Of the variables having significant bivariate relatio n ships with alliance scores, only a few were identified as significant pre dictors in multiple regression equations. Among outpatients, client age and motivational readiness to change remained positive predictors and client e ducation a negative predictor of client ratings of the the alliance, while client gender remained a significant predictor of therapist ratings. Among aftercare clients, readiness to change and level of depression remained sig nificant predictors of client ratings, while none of the variables remained a significant predictor of therapist ratings. Conclusions: While the data indicate that several client variables predict the nature of both the clien t's and therapist's perception of the therapeutic alliance, the significant relationships are of modest magnitude, and few variables remain predictive after controlling for causally prior variables. The strongest relationship identified in both the outpatient and aftercare samples is that between cl ients' motivational readiness to change and their ratings of the alliance.