The impact of counselor recovery status, disclosure, education, and experience on the working alliance in the treatment of substance use disorders .

摘要

Although evidence shows that between 30 and 75 percent of alcohol and other drug (AOD) counselors are themselves in recovery from a substance use disorder, dated research comparing the effectiveness of recovering and non-recovering counselors failed to control for education, experience, and use of disclosure. Given that the strength of the working alliance between client and counselor is highly predictive of outcome and utilizing interpersonal influence theory as an organizing framework, a path model was hypothesized which posited (a) counselor recovery status and its disclosure impact counselor attractiveness which, in turn, impacts working alliance; (b) counselor education impacts counselor expertness which, in turn, impacts working alliance; and (c) counselor experience impacts counselor trustworthiness which, in turn, impacts working alliance.;To test this model, a causal comparative/ex post facto design was used. Participants included 31 AOD counselors and 180 clients receiving inpatient and residential treatment for a substance use disorder. Counselor recovery status, disclosure, education, and experience were collected using forms designed by the investigator. Counselor attractiveness, expertness, and trustworthiness were assessed with the Counselor Rating Form-Short, while working alliance was assessed with the Working Alliance Inventory. Data were collected from seven inpatient and residential programs in Albany, New York. A path analysis was done using a series of multiple regression analyses.;Recovery status and education had significant indirect effects on working alliance. Specifically, counselors in recovery were perceived as significantly more attractive to clients and those perceived as more attractive had a significantly stronger working alliance (B = 1.992, p .05). Likewise, more educated counselors were perceived as more expert to clients and those perceived as more expert had a significantly stronger working alliance (B = 2.434, p .01). Experience and disclosure had neither significant direct nor indirect effects on working alliance.;This investigation demonstrates the impact of counselor recovery status and education on working alliance. A chief limitation is the lack of control for other client variables that also affect working alliance, including quality of current and past relationships and counselor gender. Nevertheless, a key theoretical implication is that counselor recovery and education are not sufficient to impact working alliance; a client must perceive these things. Consequently, a key practice implication is that both recovering and non-recovering counselors can promote a stronger working alliance by identifying and utilizing skills that enhance a client's perception of expertness and attractiveness. Future research must take into account counselor recovery status and education when studying the effects of counselor characteristics on treatment outcomes.