Strong ‘therapeutic alliance’ can be key to successful treatment of alcohol use disorder

A positive, trusting relationship between counselor and patient, known as a "therapeutic alliance," can be key to successful treatment of alcohol use disorder, a new study finds.

Gerard Connors, PhD, senior research scientist at the University at Buffalo Research Institute on Addictions, studied more than five dozen people engaging in a 12-week program of cognitive behavior therapy for alcohol use disorder.

Patients who reported the most positive relationships with their counselors on a session-to-session basis had fewer days of drinking and fewer days of heavy drinking between treatment sessions than patients whose relationship was not as positive.

The results indicate that efforts to ensure a good match between patient and counselor can have considerable benefits to the patient's recovery, Connors says. Further research on what factors lead to strong therapeutic alliances in alcohol treatment could be warranted.

Historically, there was an expectation that the most effective process to treat alcohol use disorder involved therapists confronting their clients about their behavior. However, Connors' work over several years, along with other emerging research, has shown a more positive relationship between therapist and client yields better results.

"Many recent studies have recognized that a positive therapeutic alliance between a therapist and client is necessary for achieving behavior change, but much less has been known about how alliances operate across a full course of treatment," Connors says.

"By studying the alliance on a session-to-session basis, we could see how a fractured alliance at a given point in time interferes with the pursuit of treatment goals by running the risk of a client dropping out of treatment," he says. "Therefore, it's important for the therapist to continue assessing the alliance throughout the entire course of treatment."

The study also showed a positive alliance was even more critical for patients who had not made changes in their drinking prior to starting treatment. "In contrast, patients who had already reduced their drinking prior to entering treatment were not as dependent on the therapeutic alliance to continue the process of behavior change," Connors says.