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Antisocial personality and the therapeutic alliance
Dissertation

Antisocial personality and the therapeutic alliance

Linda Jean Gerstley
Doctor of Philosophy (Ph.D.), Hahnemann University
Jun 1988
DOI:
https://doi.org/10.17918/00007255
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Gerstley_Linda_19884.08 MB
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Abstract

Antisocial Personality Disorder--therapy Clinical Psychology
This research explored the extent to which antisocial addicts' assessments of the therapeutic alliance were correlated with similar assessments made by their drug counselors and psychotherapists and then examined the association between these assessments and treatment outcome at seven months. The assessments of the therapeutic alliance were made at one month into the treatment process using Helping Alliance Questionnaires (Alexander and Luborsky, 1984). Six outcome measures were used. These included five composite scores derived from the Addiction Severity Index (McLellan et al., 1985) which provide ratings of patient status in the following areas: (1) Drug usage; (2) Alcohol usage; (3) Legal status; (4) Employment status and; (5) Medical status. The SCL-90 was used as a measure of psychiatric symptomatology. The first phase of this research examined intercorrelations among the patients', therapists' and counselors' assessments of relationship quality. Counselors and therapists did not agree in terms of their assessments of the quality of their relationships with the same patient although the antisocial addicts showed some similarity in terms of the ways that they assessed their relationships with both their counselors and therapists. The strongest agreement was seen in the assessments made by partners in the dyadic counselor-patient and therapist-patient relationships. The extent to which each of the assessments of the therapeutic alliance were correlated with treatment outcome was addressed. Neither the counselors' assessment nor the patients' assessments of their relationship with their counselor were related to overall outcome. However, positive assessments of the therapeutic alliance made by either the patient or his therapist were associated with a positive overall outcome. Although neither of these assessments were correlated with reduced psychiatric symptomatology, both were found to be related to improved employment status. A positive assessment of the therapeutic alliance made by the patient also was associated with reduced drug usage at seven months. The finding of a positive association between both the patient's and therapist's assessment of the therapeutic alliance and improved functioning lends support to the idea that there are some addicts who meet the DSM-III criteria for Antisocial Personality Disorder who are capable of forming a meaningful relationship with a therapist; and, in turn, are able to benefit from psychotherapy. (Abstract shortened with permission of author.).

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