Untangling the Alliance-Outcome Correlation: Exploring the Relative Effect of Age and Gender in Treatment of Adolescence Substance Abuser


Although the relationship between the therapeutic alliance and outcome has long been established
across numerous studies and meta-analyses, less is known about this in treatment of adolescence substance abuse. This study investigates factors that influence alliance- outcome relationship in adolescence substance abuse treatment. To achieve this objective, this study explored the relative effect of demographic variables, i.e., (age and gender) in a sample of adolescent substance abuser at the rehabilitation treatment centre of University college hospital, (UCH) Ibadan, Oyo State Nigeria. Fifty –three adolescents took part in this study, and completed self-report measures of readiness and expectation (client’s theory of change) prior to treatment, therapeutic alliance measures during treatment. The findings indicates that, age do not predict alliance-outcome relationship in adolescence substance abuse treatment, as there was no moderating effect for client’s age. In addition, the finding showed a significant sex difference in pre-treatment motivational variables, client ratings of the alliance and treatment outcome. Finally, it was suggested that early identification of demographic variables that influence adolescent’s treatment; asadolescent’s attributions of resistance are associated with age and gender.


therapeutic alliance; adolescent substance abuse; demographic variables; alliance-outcome correlations

Baldwin S.A., Wampold B.E., Imel Z.E., 2007, Untangling the Alliance–Outcome Correlation: Exploring the Relative Importance of Therapist and Patient Variability in the Alliance, „Journal of Consulting and Clinical Psychology”, 75, s. 842–852.

Barber J.P., Connolly M.B., Crits-Christoph P., Gladis L., Siqueland L., 2001, Alliance Predicts Patients’ Outcome Beyond In-Treatment Change in Symptoms, „Journal of Consulting and Clinical Psychology”, 68, s. 1027–1032.

Barrowclough C., Meier P., Beardmore R., Emsley R., 2010, Predicting Therapeutic Alliance in Clients with Psychosis and Substance Misuse, „Journal of Nervous and Mental Disease”, 198, s. 373–377.

Bem S., 1981, Gender Schema Theory: A Cognitive Account of Sex Typing, „Psychological Review”, 88, s. 354–364.

Bordin E.S., 1979, The Generalizability of the Psychoanalytic Concept of the Working Alliance, „Psychotherapy: Theory, Research and Practice”, 16, 252–260.

Castonguay L.G., Holtforth M.G., 2005, Change in Psychotherapy: A Plea for no More Nonspecific and False Dichotomies, „Clinical Psychology: Science and Practice”, 12, s. 198–201.

Cottone J.G., Drucker P., Javier R.A., 2002, Gender Differences in Psychotherapy Dyads: Changes in Psychological Symptoms and Responsiveness to Treatment During 3 Months of Therapy, „Psychotherapy: Theory, Research, Practice, Training”, 39, s. 297–308.

Craighead W.E., Bjornsson A.S., Amarson E.O., 2005, Specificity and Nonspecifity in Psychotherapy, „Clinical Psychology: Science and Practice”, 12, s. 189–193.

DeRubeis R.J., Brotman M.A., Gibbons C.J., 2005, A Conceptual and Methodological Analysis of the Nonspecifics Argument, „Clinical Psychology: Science and Practice”, 12, s. 174–183.

Diamond G.S., Liddle H.A., Wintersteen M.B., Dennis M.L., Godley S.H., Tims F., 2006, Early Therapeutic Alliance as a Predictor of Treatment Outcome for Adolescent Cannabis Users in Outpatient Treatment, „The American Journal on Addictions”, 15(Suppl. 1), s. 26–3.

Dinger U., Strack M., Leichsenring F., Wilmers F., Schauenburg H., 2008, Therapist Effects on Outcome and Alliance in Inpatient Psychotherapy, „Journal of Clinical Psychology”, 64, 344–354.

Dinger U., Strack M., Sachsse T., Schauenburg H., 2009, Therapists’ Attachment, Patients’ Interpersonal Problems and Alliance Development over Time in Inpatient Psychotherapy, „Psychotherapy: Theory, Research, Practice, Training”, 46, s. 277–290.

DiGiuseppe R., Linscott J., Jilton R., 1996, Developing the Therapeutic Alliance in Child-Adolescent Psychotherapy, „Applied & Preventive Psychology”, 5(2), s. 85–100.

Drug Strategies, 2003, Treating Teens: A Guide to Adolescent Drug Programs, Washington, DC: Drug Strategies.

Elvins R., Green J., 2008, The Conceptualization and Measurement of Therapeutic Alliance: An Empirical Review, „Clinical Psychology Review”, 28, s. 1167–1187.

Fabrikant B., 1974, The Psychotherapist and the Female Patient: Perceptions, Misperceptions, and Change, [w:] Women in therapy, (red.) Franks V., Burtle M.A., Brunner/Mazel, New York.

Festinger L., 1954, A Theory of Social Comparison Processes, „Human Relations”, 7, s. 117–140.

Fitzpatrick M.R., Iwakabe S., Stalikas A., 2005, Perspective Divergence in the Working Alliance, „Psychotherapy Research”, 15, s. 69–80.

Freud S., 1913, On Beginning the Treatment, [w:] The Standard Edition of the Complete Psychological Works of Sigmund Freud, (red. i tłum.) Strachey J., Vol. 12, Hogarth Press, London.

Gamer B.R., Godley M.D.; Funk R.R., Dennis M.L., Godley S.H., The Impact of Continuing Care Adherence on Environment Risks, Substance Use and Substance-Related Problems Following Adolescent Residential Treatment, „Psychology of Addictive
Behaviors” (w druku).

Gelso C.J., Carter J.A., 1994, Components of the Psychotherapy Relationship: Their Interaction and Unfolding During Treatment, „Journal of Counseling Psychology”, 41, s. 296–306.

Greenstein D.K., Franklin M.E., McGuffin P., 1999, Measuring Motivation to Change: An Examination of the University of Rhode Island Change Assessment Questionnaire (URICA) in an Adolescent Sample, „Psychotherapy: Theory, Research, Practice, Training”,
36(1), s. 47–55.

Hatcher R.L., Barends A.W., 2006, Thinking about the Alliance in Practice, „Psychotherapy, Therapy, Research, Practice, Training”, 41, s. 7–10.

Hogue A., Dauber S., Stambaugh L.F., Cecero J.J., Liddle H.A., 2006, Early Therapeutic Alliance and Treatment Outcome in Individual and Family Therapy for Adolescent Behavior Problems, „Journal of Consulting and Clinical Psychology”, 74, s. 121–29.

Horvath A.O., 1981, An Exploratory Study of the Working Alliance: Its Measurement and Relationship to Outcome, niepublikowana rozprawa doktorska, University of British Columbia.

Horvath A.O., 2002, The Alliance, „Psychotherapy: Theory, Research, Practice, Training”, 38, s. 365–372.

Horvath A.O., 2005, The Therapeutic Relationship: Research and Theory, „Psychotherapy Research”, 15, s. 3–7.

Horvath A.O., Bedi R.P., 2002, The Alliance, [w:] Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients, (red.) Norcross J.C., Oxford University Press, New York, s. 37–70.

Horvath A., Del Re A.C., Flückiger C., Symonds D., 2011, The Alliance, [w:] Relationships that Work, (red.) Norcross J.C., Oxford University Press, New York, s. 25–69. Olusegun E. Afolabi, Fatai A. Adebayo 230 (s. 211–231)

Kazdin A.E., 2005, Treatment Outcomes, Common Factors, and Continued Neglect of Mechanisms of Change, „Clinical Psychology: Science and Practice”, 12, s. 184–188.

Lambert A., Barley D., 2002, Research summary on the therapeutic relationship and psychotherapy outcome, [w:] Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients, (red.) Norcross J., Oxford University Press,
New York.

Lambert M., Ogles B., 2004, The Efficacy and Effectiveness of Psychotherapy, [w:] Handbook of Psychotherapy and Behavior Change, (red.) Lambert M., Wiley, New York, s. 139–193,

Liese B.S., Beck A.T., 1995, Back to Basics: Fundamental Cognitive Therapy Skills for Keeping Drug-Dependent Individuals in Treatment, [w:] Beyond the Therapeutic Alliance: Keeping the Drug-Dependent Individual in Treatment, Vol. 165, NIDA, Rockville,
s. 207–230.

Luborsky L., Auerbach A., Chandler M., Cohen J., Bachrach H., 1971, Factors Influencing The Outcome of Psychotherapy: A Review of Quantitative Research, „Psychological Bulletin”, 75, s. 145–184.

Mallinckrodt B., 2000, Attachment, Social Competencies, Social Support, and Interpersonal Process in Psychotherapy, „Psychotherapy Research”, 10, s. 239–266.

Marcus D.K., Kashy D.A., Baldwin S.A., 2009, Studying Psychotherapy Using the One-With-Many Design: The Therapeutic Alliance as an Exemplar, „Journal of Counseling Psychology”, 56, s. 537–548.

Marcus D.K., Kashy D.A., Wintersteen M.B., Diamond G.S., 2011, The Therapeutic Alliance in Adolescent Substance Abuse Treatment: A One-With-Many Analysis, „Journal of Counseling Psychology”, 58(3), s. 449–455.

Martin D.J., Garske J.P., Davis K.M., 2000, Relation of the Therapeutic Alliance with Outcome and Other Variables: A Meta Analytic Review, „Journal of Consulting and Clinical Psychology”, 68, s. 438–450.

McConnaughy E.A., Prochaska J.O., Velicer W.F., 1983, Stages of Change in Psychotherapy: Measurement and Sample Profiles, „Psychotherapy: Theory, Research, Practice, Training”, 20(3), s. 368–375.

Meier P.S., Barrowclough C., Donmall M.C., 2005, The Role of the Therapeutic Alliance in the Treatment of Substance Misuse: A Critical Review of the Literature, „Addiction”, 100, 304–316.

Norcross J.C. (red.), 2002, Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients, Oxford University Press, New York.

Orlinsky D.E., Ronnestad M.H., Willutzski U., 2004, Fifty Years of Psychotherapy Process-Outcome Research: Continuity and Change, [w:] Bergin and Garfield’s Handbook of Psychotherapy and Behaviour Change, (red.) Lambert M., 5th ed., Wiley, New
York, s. 307–389.

Rogers C.R., 1957, The Necessary and Sufficient Conditions of Therapeutic Personality Change, „Journal of Consulting Psychology”, 21, s. 95–103.

Shirk S.R., Karver M., 2003, Predictions of Treatment Outcome From Relationship Variables in Child and Adolescent Therapy: A Meta-Analytic Review, „Journal of Consulting and Clinical Psychology”, 71, s. 452–464.

Simpson D.D., 2004, A Conceptual Framework for Drug Treatment Process and Outcomes, „Journal of Substance Abuse Treatment”, 27, s. 99–121.

Strunk D.R., Brotman M.A., DeRubeis R.J., 2010, The Process of Change in Cognitive Therapy for Depression Inter-Session Symptom Gains, „Behaviour Research and Therapy”, 48, s. 599–606.

Tetzlaff B.T, Kahn J.H, Godley S.H, Godley M.D., Diamond G.S., Funk R.R., 2005, Working Alliance, Treatment Satisfaction, And Patterns of Posttreatment Use Among Adolescent Substance Users, „Psychology of Addictive Behaviors”, 19, s. 199–207.

Tracey T.J., Kokotovic A.M., 1989, Factor Structure of the Working Alliance Inventory, „Psychological Assessment”, 1, s. 207–210.

Wampold B.E., Brown G.S., 2005, Estimating Variability in Outcomes Attributable to Therapists: A Naturalistic Study of Outcomes in Managed Care, „Journal of Consulting and Clinical Psychology”, 73, s. 914–923.

Weissman M.M., Orvaschel H., Padian N., 1980, Children’s Symptom and Social Functioning Self-Report Scales: Comparison of Mothers’ and Children’s Reports, „Journal of Nervous Mental Disorders”, 168(12), s. 736–740.

Zuroff D.C., Kelly A.C., Leybman M.J., Blatt S.J., Wampold B.E., 2010, Between-Therapist and Within-Therapist Differences in the Quality of the Therapeutic Relationship: Effects on Maladjustment and Self-Critical Perfectionism, „Journal of Clinical Psychology”, 66, s. 681–697.

Źródła internetowe

Ogles B.M., Melendez G., Davis D.C., Lunnen K.M., 2000, The Ohio Youth Problem, Functioning, and Satisfaction Scales: Technical manual, available: http://sites.google.com/site/ohioscales/the-manuals

Published : 2017-07-28

Afolabi, O., & Adebayo, F. (2017). Untangling the Alliance-Outcome Correlation: Exploring the Relative Effect of Age and Gender in Treatment of Adolescence Substance Abuser. Resocjalizacja Polska, (13), 211-231. https://doi.org/10.22432/pjsr.2017.13.14

Olusegun E. Afolabi  afo13@yahoo.com
Department of Educational Foundations University of Botswana 
Fatai A. Adebayo 
Department of Statistics Uversity of Botswana 

CitedBy Crossref

CitedBy Scopus

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright Notice:

Articles are published in accordance with conditions identical to the Creative Commons Attribution 4.0 (also called as CC-BY) license conditions, available on http://creativecommons.org/licenses/by/4.0/ and this permission applies to any language version or any later version of the license as published by the Creative Commons organization.

Author retain the copyright to the article, while at the same time he/she transfers the article property rights to the Publisher free of charge (without territorial and time restrictions).

The online edition of the Polish Journal of Social Rehabilitation is published under Open Access, which means that users can read, download, copy, distribute, print, search, and link to the full texts of these articles - are provided with full unrestricted access.

The publisher does not charge for providing access to full versions of articles nor for their use as referred to in above.