Relationship between working alliance and client outcomes: the role of substance use

This study examined the role of substance use in the relationship between the working alliance and outcome symptomatology. In this study, two groups of participants were formed: the at risk for substance abuse (ARSA) group consisted of participants who indicated 'almost always,' 'frequently,' 'sometimes,' or 'rarely' on either of two items on the Outcome Questionnaire-45.2 (OQ-45.2) (i.e., the eye-opener item: "After heavy drinking, I need a drink the next morning to get going" and the annoyed item: "I feel annoyed by people who criticize my drinking (or drug use)"). The non-ARSA group consisted of participants who indicated 'never' on both of the eye-opener and annoyed screening items on the OQ-45.2. Data available from a counselor-training center for a client participant sample (n = 68) was used. As part of the usual counselor training center procedures, clients completed questionnaires after their weekly counseling session. The measures included the Working Alliance Inventory and the OQ-45.2. Results revealed no significant differences between the ARSA and non-ARSA groups in working alliance, total outcome symptomology, or in any of the three subscales of symptomatology. Working alliance was not found to be significant in predicting outcome symptomatology in this sample and no moderation effect of substance use on the relationship between working alliance and outcome symptomatology was found. This study was a start into the exploration of the role of substance use in the relationship between working alliance and outcome symptomatology in individual psychotherapy. Further research should be conducted to better understand substance use populations in individual psychotherapy.