Evidence-Based Relationships: The Science of Relationships that Work

The NADCP Adult Drug Court Best Practice Standards champion the use of evidence-based practices, based on the best available research. While research can tell us what models and interventions work, the how of their delivery is less often discussed. The most effective treatment court teams go beyond the “what” of their program’s offerings (evidence-based practices) and relate to participants in ways that support and promote recovery (evidence-based relationships).  
 
A Task Force on Evidence-Based Relationships was formed by the American Psychological Association to analyze the best available research to identify the core components of effective therapy relationships (Norcross & Wampole, 2011). The Task Force concluded that the therapeutic alliance, empathy, and gathering client feedback are clearly linked to positive outcomes. The therapeutic alliance entails mutually agreed upon goals, agreed upon tasks, and a sense of collaboration and relational bond between the two parties. Multiple rigorous studies also indicate that therapists who can express empathy (understand and acknowledge the client’s perspective) and who actively monitor client’s perceptions and responses to treatment are more effective. Relationship behaviors deemed ineffective and potentially harmful include a confrontational style, therapist comments that are hostile or blaming, judging the person versus their behavior, and applying a one-size-fits-all approach that ignores individual and cultural differences. 
 
Relevance to Treatment Courts
 
While most members of treatment court teams are not therapists, the Task Force’s findings detail what works and doesn’t work in relationships that target lasting personal change. The following can apply to every court team role:
 
  • To enhance the relational alliance, treatment court team members should frequently discuss participants’ personal values and motivations, and collaboratively review program and client expectations. 
  • While these relationships must remain professional, expressing genuine caring for participants can help form bonds that are healthy, respectful and meaningful.
  • Directly asking clients for feedback about the program and their experiences provides opportunities to improve collaboration, to modify approaches as needed, and prevent premature termination. 
  • Confrontation has historically been a problem in the addictions field. Interactions that are infused with motivational enhancement elements, such as rolling with resistance, reflective responding and active listening serve as antidotes to these all-too-human, but toxic reactions.  
  • Individualized treatment plans that consider the individual’s unique and diverse identities are a hallmark of treatment court Best Practices, and the Task Force’s findings confirm this. “Fair treatment” does not equal “identical treatment.” It means tailoring the program and services to match the evolving needs of each individual.
 
Treatment court involvement is essentially a series of human interactions, so relationships between participants and the team are central to recovery. Substance use and criminal behavior can be viewed as rooted in disturbed relationships, disconnection and alienation, and treatment court professionals have the opportunity to make lasting impacts–not only via evidence-based techniques and operational models–but through meaningful, evidence-based connections.  
 

References: 

Norcross, J.C. & Wampole, B.E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102.
 

Written by Sally MacKain, Ph.D., LP; NDCRC Director of Clinical Treatment

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