From Compliance to Alliance: Strengthening the Working Alliance in Mandated Treatment

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Virginia Tech

Over the past three decades, the United States criminal justice system and mental health treatment providers have collaborated in ways to support more than 20.3 million individuals who are struggling with a substance use disorder (SUD), and who may also be facing drug-related offenses due to their ongoing challenges combatting addiction. Through collaborative efforts we have been fortunate to witness the establishment of adult drug treatment courts, as well as other problem-solving court processes. With more than 1,500 active adult drug treatment court programs in this country, there is a critical need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment.
Adult drug treatment court programs have been shown to have discrepant success outcomes (8% to 80%) in terms of reducing criminal recidivism; moreover, the existing literature examining the lived experiences of participants in these programs is both minimal and disheartening. This lack of empirical data is problematic for the counseling profession given that they serve as key change agents in this process. What we do know is that the process of creating treatment goal and modalities, which should be in the hands of the clients and their counselors, can be complicated by court-mandated requirements. This bi-level structure has the potential to create ruptures in the working alliance between clients and counselors providing SUD treatment to this population. Accordingly, additional research is needed to explore the client experience within the working alliance, and in so doing reveal the influences at play when working with clients who are mandated to receive SUD treatment. This qualitative study was guided by one central research question: How do clients experience the working alliance with counselors during drug court-mandated addictions treatment? Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients.

Working alliance, mandated treatment, drug court, substance use disorder treatment