Across the Prison Divide: the Role of Therapeutic Alliance in Treatment of Mandated Substance Abuse Clients

Abstract

The therapeutic alliance has been studied over many decades and suggested to be an important element in successful treatment outcomes. A number of studies have discussed the relationship between alliance and substance abuse treatment. However, similar research of mandated treatment within the criminal justice system has received less attention. Mandating to treatment appears to be increasing, and society will benefit from effective programme interventions. In addition, the knowledge gained in turning attention to this neglected area of study can shed light on the role of therapeutic alliance in others mandated to therapy outside the justice system. The thesis reports on Study A, a proposal for a grounded theory study and a call for further research, and Study B, a pilot project that grounded an emergent theory in the data obtained from interviews with 4 justice system programme facilitators in a midsized Canadian city. Through open, axial, and selective coding the Initiated and Discretionary Facilitation (IDF) theory is proposed. The development of a therapeutic alliance with mandated clients within the context of the criminal justice system is a function of mandate relatedness, moderated by the intervening conditions of the system’s management mandates (MM) and client persona and values (CP/v), both of which can either be facilitated or inhibited by two primary facilitation strategies: initiated actions (IA) and discretionary facilitation (DF). IDF proposes that DF is a high level facilitator skill, by which helpers overcome both systemic underestimations of the value of therapeutic alliance and resource limitations for the specific development of the alliance in substance abuse programme delivery.