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Unformatted text preview: THE ROLE OF THE ALLIANCE AND TECHNIQUES IN PREDICTING OUTCOME OF SUPPORTIVE-EXPRESSIVE DYNAMIC THERAPY FOR COCAINE DEPENDENCE Jacques P. Barber, PhD, Robert Gallop, PhD, Paul Crits-Christoph, PhD, Marna S. Barrett, PhD, Susan Klostermann, BA, Kevin S. McCarthy, MA, and Brian A. Sharpless, PhD, MA University of Pennsylvania Medical School We examine the complex relations among therapeutic alliance, adherence to Supportive-Expressive Therapy (SET), therapist competence, and their in- teractions in predicting change in drug use. Experts rated early therapy sessions of cocaine dependent patients ( n 5 108) randomized to SET as part of the Collaborative Cocaine Treatment Study. Moderate adherence to SET and competent delivery of SET were separately associated with poorer outcome. Further, strong alliance combined with low levels of SET adher- ence was associated with a better outcome than moderate or high levels. Moreover, the usage of nonprescribed techniques (i.e., Individual Drug Counseling [IDC]) by SET therapists predicted better outcome in a sub- sample ( n 5 36), and SET patients receiving high levels of IDC adherence had less predicted drug use compared with those with high levels of SET techniques. Overall results may suggest that decreasing cocaine use through straightforward drug counseling techniques instead of trying to help patients understand the reasons for their use is a better initial road to recovery. Keywords: alliance, therapy outcome, psychodynamic therapy, cocaine depen- dence, drug counseling Jacques P. Barber, PhD, Robert Gallop, PhD, Paul Crits-Christoph, PhD, Marna S. Barrett, PhD, Susan Klostermann, BA, Kevin S. McCarthy, MA, and Brian A. Sharpless, PhD, MA, Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania Medical School. Author Note : The NIDA Collaborative Cocaine Treatment Study is a National Institute on Drug Abuse (NIDA) funded Cooperative Agreement involving four clinical sites, a Coordinating Center, and NIDA staff. The Coordinating Center at the University of Pennsylvania includes: Paul Crits- Christoph, PhD (PI), Lynne Siqueland, PhD (Project Coordinator), Karla Moras, PhD (Assessment Unit Director), Jesse Chittams, MA, and Robert Gallop, PhD (Directors of Data Management), and Larry Muenz, PhD (Statistician). The collaborating scientists at the Treatment Research Branch, Psychoanalytic Psychology Copyright 2008 by the American Psychological Association 2008, Vol. 25, No. 3, 461482 0736-9735/08/$12.00 DOI: 10.1037/0736-97184.108.40.2061 461 Over the past few decades, the use of psychodynamic treatments has declined (Norcross, Hedges, & Castle, 2002; Norcross, Karpiak, & Santoro, 2005) despite a growing body of evidence suggesting the efficacy of dynamic therapy for treating a variety of clinical disorders (e.g., Leichsenring, Rabung, & Leibing, 2004), including addictions. For in- stance, two studies of Supportive-Expressive dynamic therapy (SET) for treatment of methadone-maintained opiate addicted patients (Woody, OBrien, & McLellan, 1984;...
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This note was uploaded on 03/06/2011 for the course PSYCH 212 taught by Professor Dansullivan during the Spring '11 term at NYU.
- Spring '11