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The alliance in motivational enhancement therapy and counseling as usual for substance use problems.

Data from a community-based multicenter study of motivational enhancement therapy (MET) and counseling as usual (CAU) for outpatient substance users were used to examine questions about the role of the alliance in MET and CAU. Most (94%) of the sample met diagnostic criteria for abuse or dependence (primarily alcohol and/or cocaine). Sixteen therapists for CAU and 14 for MET participated. No reliable differences in patient ratings (n = 319) on the Helping Alliance Questionnaire-II (HAq-II) were evident for MET compared to CAU, but significant differences between therapists were found within each condition in mean patient-rated HAq-II scores. Overall, average levels of alliance were high. The between-therapists component of the alliance, but not the within-therapist component, was significantly associated with self-reported days of primary substance use during the follow-up period from Week 4 to Week 16 (Cohen's d = 0 .39; n = 257). Therapists with either low or very high alliances had relatively poorer average outcomes (quadratic effect, d = 0.44). For therapists in both MET and CAU, increased use of MET fundamental techniques and MET advanced techniques during treatment sessions was associated with higher levels of alliance. Implications of the findings for conceptualization of the alliance and for training of therapists are discussed.

Pubmed ID: 19968388


  • Crits-Christoph P
  • Gallop R
  • Temes CM
  • Woody G
  • Ball SA
  • Martino S
  • Carroll KM


Journal of consulting and clinical psychology

Publication Data

December 8, 2009

Associated Grants

  • Agency: NIDA NIH HHS, Id: P50 DA009241
  • Agency: NIDA NIH HHS, Id: R01 DA018935
  • Agency: NIDA NIH HHS, Id: R01 DA018935-01
  • Agency: NIDA NIH HHS, Id: R01-DA018935
  • Agency: NIDA NIH HHS, Id: U01 DA13038
  • Agency: NIDA NIH HHS, Id: U01 DA13043
  • Agency: NIDA NIH HHS, Id: U01 DA13045

Mesh Terms

  • Adult
  • Behavior Therapy
  • Counseling
  • Female
  • Humans
  • Male
  • Middle Aged
  • Motivation
  • Patient Compliance
  • Patient Selection
  • Professional-Patient Relations
  • Psychiatric Status Rating Scales
  • Questionnaires
  • Regression Analysis
  • Substance-Related Disorders
  • Treatment Outcome