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Dissertation
The effect of therapeutic alliance on perceived levels of formal and informal coercion
Doctor of Philosophy (Ph.D.), Medical College of Pennsylvania and Hahnemann University; Villanova University, School of Law
Aug 1999
DOI:
https://doi.org/10.17918/00008121
Abstract
Numerous studies have examined the role of coercion to affect mental health and substance abuse treatment entry, but only recently have researchers begun to examine the role of perceived coercion to enter treatment, which encompasses not only legal forms of coercion, but also non-legal coercion and pressures from family, friends, and others in the community. Therapeutic alliance is a concept that has been studied concerning treatment retention and outcome, but which has not been studied in relation to its effect on perceived coercion to enter treatment. This study examines differences between legally mandated and non-legally mandated patients on levels of perceived coercion to enter substance abuse treatment, as well as the effect of the therapeutic alliance on altering intake levels of perceived coercion. Participants were 69 males with a mean age of 33 years entering drug treatment into two treatment sites in Philadelphia that accept both legally mandated and non-legally mandated patients. Participants included 47 legally mandated and 22 non-legally mandated patients, who were tested at treatment intake for levels of both perceived coercion and procedural justice, and who made prospective assessments of later therapeutic alliance. Approximately six weeks into treatment, the 39 remaining participants were tested again on actual levels of therapeutic alliance, and reassessed for levels of perceived coercion and procedural justice. ANOVAs were used to test for differences between the legally mandated and non-legally mandated participants on the intake measures. Intake results revealed that legally mandated and non-legally mandated participants differed significantly on intake levels of perceived coercion, but did not differ on prospective assessments of therapeutic alliance. Comparison of two perceived coercion instruments revealed the Survey of Treatment Entry Pressures is more sensitive to detecting nonlegal sources of coercion than the MacArthur Admission Experience Survey. Correlational analyses performed on the data collected six weeks later revealed that changes in levels of therapeutic alliance were negatively correlated with changes in levels of perceived coercion, and positively correlated with changes in levels of procedural justice. Implications for drug treatment policy are discussed and directions for future research are proposed.
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Details
- Title
- The effect of therapeutic alliance on perceived levels of formal and informal coercion
- Creators
- Craig R. Lareau
- Contributors
- Kirk Heilbrun (Advisor) - Drexel University, Medical College of Pennsylvania and Hahnemann University (1993-1996, 1998-2002)
- Awarding Institution
- Medical College of Pennsylvania and Hahnemann University; Villanova University, School of Law
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Medical College of Pennsylvania and Hahnemann University; Villanova University, School of Law; Philadelphia, Pennsylvania
- Number of pages
- vii, 158 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Medical College of Pennsylvania and Hahnemann University (1993-1996, 1998-2002); Clinical and Health Psychology [Historical]; School of Health Professions (1998-2000)
- Other Identifier
- 991021888828204721