Therapists’ experiences of the therapeutic alliance with clients with drug problems: An interpretative phenomenological analysis

The therapeutic alliance is fundamental for therapists who work with clients with drug problems. The alliance is central to engaging and retaining clients with drug problems in treatment and in facilitating a positive treatment outcome. Moreover, clients with drug problems may have significant difficulties in relating to others, which manifests itself in the client-therapist relationship. There is a paucity of research investigating therapists’ perceptions of the alliance with clients who use drugs. Consequently, this study aimed to explore how therapists experience and understand the alliance with clients who use drugs. Six therapists were interviewed and their narratives analysed using Interpretative Phenomenological Analysis.
The data analysis generated four superordinate themes; Trapped in the system; Struggling to connect; The contradictory therapist and Resources transcending the alliance. The themes illustrate the participants’ experiences of how they have little choice but to work within a treatment system they perceive as impacting upon the alliance. Moreover, most participants experience their clients as unreachable, and the results suggest that therapists may take responsibility for developing and maintaining the alliance to accommodate their clients’ ambivalence. The participants further seem contradictory in their understanding of the alliance, which indicates their struggle to acknowledge the difficulties and differences in forming the alliance with their clients as opposed to with generic clients. The participants describe how clinical supervision, peer support and the use of self enable them to connect with their clients. Finally, the study demonstrates that the participants experience the alliance as heavily intertwined with unconscious processes.
The study results suggest that therapists require specific and structured support to acknowledge and manage the challenges inherent in relating to clients with drug problems, focussing particularly upon the use of self and the management of countertransference. Moreover, the study highlights the necessity of acknowledging the therapeutic alliance as inseparable from unconscious processes. Additional recommendations are made in relation to clinical practice, training and research.