In drug abuse cases, judges are considering placement in a drug counseling program as an alternative to incarceration. Who is more likely to benefit from drug treatment as an alternative to incarceration? A recent study connects client success in a drug abuse program with the fundamental ability to form social attachments, specifically with a counselor [Jl. Clin. Psychology, Vol. 53(3), 215-224 (1997)].
The researchers used the term “therapeutic connection” to describe the client-counselor relationship and identified four elements comprising it: trust, dependency; openness, and acceptance. In a 139-subject longitudinal study of clients in drug abuse treatment, they found statistically significant associations (1) between a client, his initial level of psychological functioning and therapeutic connection to his counselor, and (2) between this connection and subsequent improvement in functioning.
The subjects were randomly assigned to two 28-day drug abuse treatment programs (82 in a residential program, 57 in a day program) at a treatment facility for indigent drug users in Houston, Texas. Both programs conducted the same eight-hour-per-day schedule of educational and therapeutic programs. The 139 subjects completed three self-administered Outlook of Life Surveys (015)—one at intake and two semiweekly thereafter.
By collecting data from clients before and during treatment, antecedents and consequences of therapeutic connection could be studied. Psychological functioning was defined as the self-esteem score minus the anxiety and depression scores on a scale developed by Simpson. A scale measuring emotional connection, based on Bell, assessed trust, dependency, openness, and acceptance; the sum of these four elements defined the level of a client's therapeutic connection as reported on the first OLS.
The overall result of the study was that those clients with greater levels of therapeutic connection reported greater progress. Healthier clients formed better counselor relationships, which in turn were associated with client psychological progress. Those clients who formed stronger connections with their counselors showed more psychological change during treatment.
Many who enter the corrections system have poor interpersonal skills and pathological ways of relating to others, especially those with antisocial personality disorder. This study raises the consideration that the design of forensic drug treatment programs for these sicker individuals should include group process work that enhances their ability to work with a counselor, and a support system for maintaining abstinence.
