Therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis
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Background This paper examines the role of therapeutic alliance in predicting outcomes in a Randomized Controlled Trial of Motivational Interviewing and Cognitive Behavioral Therapy (MICBT) for problematic cannabis use in recent onset psychosis.Methods All clients were participating in a three arm pragmatic rater-blind randomized controlled trial of brief MICBT plus standard care compared with longer term MICBT plus standard care and standard care alone. Participants completed measures to assess clinical symptoms, global functioning and substance misuse at baseline, 4.5months, 9months and 18months. Clients and therapists completed the Working Alliance Inventory approximately one month into therapy. Client alliance data was available for 35 participants randomized to therapy and therapist alliance data was available for 52 participants randomized to therapy.Results At baseline, poorer client-rated alliance was associated with more negative symptoms, poorer insight and greater cannabis use, whereas poorer therapist-rated alliance was only associated with amount of cannabis used per cannabis using day. Alliance ratings were also positively associated with amount of therapy: client-rated alliance was higher in the longer compared to the briefer therapy; therapist-rated alliance was associated with greater number of sessions attended (controlling for type of therapy) and therapy completion. In predicting outcome, client-rated alliance predicted total symptom scores and global functioning scores at follow-up. Neither client nor therapist alliance predicted changes in substance misuse at any time point.Conclusions Findings demonstrate that individuals with psychosis and substance misuse who form better alliances with their therapists gain greater benefits from therapy, at least in terms of improvements in global functioning.
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Lack of insight predicts drop out from cognitive behavior therapy and poorer therapeutic alliance.
“Studying interpersonal elements of treatment, Lincoln et al 37 reported that lack of insight predicted drop out from cognitive behavior therapy in patients with psychosis.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [38]
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Self-citation
- Authors
- Berry, K., Gregg, L., Lobban, F., & Barrowclough, C.
- Affiliations
- University of Manchester (GB)
- Lancaster University (GB)
- Corresponding author
- Berry, Katherine
- Venue
- Comprehensive Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 67
- Pages
- 73-80
- ISSN
- 0010-440X (ISSN-L)
- OpenAlex
- W2288559300
- Cited by
- 32
- References
- 33
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 5 · 2018: 8
- FWCI
- 5.80
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Comprehensive Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by-nc-nd)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0606-1302)
- Programme Grants for Applied Research (RP‐PG‐0606‐1302)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- therapeutic relationship, recent-onset psychosis, cannabis use, problematic cannabis use, motivational interviewing, cognitive behavioral therapy, Working Alliance Inventory, treatment outcome prediction, global functioning, substance abuse, treatment duration
- MeSH terms
- Adult, Attitude of Health Personnel, Cannabis, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Professional-Patient Relations, Psychoses, Substance-Induced, Psychotic Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Substance-Related Disorders, Motivational Interviewing
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