Therapeutic alliance and change in psychiatric symptoms in adolescents and young adults receiving drug treatment

Background: Despite a significant literature examining the processes and outcomes of formal psychotherapeutic interventions, helping relationships outside of traditional psychotherapy settings have received less empirical attention. This study examined the effect of therapeutic alliance on client outcomes within two community‐based case management services for young drug users.

Methods: The impact of therapeutic alliance on substance use and mental health outcomes was assessed over two occasions in 100 young people (aged 16–22 years) receiving case management within two youth drug and alcohol services.

Results: At baseline, those clients with non‐substance‐related mental health disorders, especially PTSD, reported a significantly worse therapeutic alliance with their case manager. Clients who rated the therapeutic alliance more positively at the beginning of intervention were more likely to evidence improvement in depressive symptoms over the follow‐up period. Conversely, higher depressive symptoms at baseline predicted deterioration in therapist‐rated alliance over the follow‐up period. No significant associations were reported between substance use ratings and the therapeutic alliance.

Conclusions: These findings with young help‐seeking substance users suggest that therapeutic alliance has a significant impact on symptom change during drug treatment, but that it interacts more strongly with depressive than substance use symptomatology.