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Therapeutic alliance dimensions and dropout in a therapeutic community: “Bond with me and I will stay”

Luís Janeiro (Department of Psychology and Educational Sciences, Centre for Research in Psychology (CIP), University of Algarve, Faro, Portugal)
Eugénia Ribeiro (Psychotherapy and Psychopathology Research Unit, Centre of Research in Psychology, School of Psychology, University of Minho, Braga, Portugal)
Luís Faísca (Department of Psychology and Educational Sciences, Centre for Biomedical Research (CBMR), University of Algarve, Faro, Portugal)
María José Lopez Miguel (Faculty of Psychology, University of Seville, Seville, Spain)

Therapeutic Communities: The International Journal of Therapeutic Communities

ISSN: 0964-1866

Article publication date: 11 June 2018

Abstract

Purpose

A better therapeutic alliance at the beginning of treatment for addictive behaviours has been found to prevent dropout. The purpose of this paper is to evaluate how the development of therapeutic alliance dimensions was associated with the dropout prevention.

Design/methodology/approach

A total of 23 participants presented a substance use disorder related to heroin or cocaine and were in three distinct treatment phases of a therapeutic community. Each participant filled in the therapeutic alliance measures once a week after mini-groups. A naturalistic prospective research design was used to collate 198 repeated alliance measures.

Findings

Participants who presented stable bond development at higher levels tended to stay in treatment, whereas those who developed stable bonds at lower levels tended to drop out. The goals and tasks dimension increased significantly across the phases and was not associated with dropout.

Practical implications

To prevent dropout, therapists should pay special attention to residents who manifest difficulties in establishing stable and secure bonds and not overestimate the impact of the goals and tasks alliance dimension, as it is not a failsafe indicator of treatment retention.

Originality/value

The alliance dimensions were differentiated (bond, goals and tasks) and studied throughout the treatment, pointing out the importance of therapeutic relationship dynamic variables to prevent dropout.

Keywords

Acknowledgements

This study was partially conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by national Portuguese funding through FCT – Fundação para a Ciência e a Tecnologia, Project Ref. UID/BIM/04773/2013 CBMR.

Citation

Janeiro, L., Ribeiro, E., Faísca, L. and Lopez Miguel, M.J. (2018), "Therapeutic alliance dimensions and dropout in a therapeutic community: “Bond with me and I will stay”", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 39 No. 2, pp. 73-82. https://doi.org/10.1108/TC-12-2017-0036

Publisher

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Emerald Publishing Limited

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