Working alliance, readiness for change, and theory of change as predictors of treatment success among incarcerated adolescents
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The working alliance has been defined as a collaborative agreement between therapist and client on the goals and tasks of therapy, together with a bond of mutual trust (Bordin, 1979). The link between a strong working alliance and positive therapy outcomes has received widespread empirical support (Horvath & Symonds, 1991; Horvath & Luborsky, 1993). In light of this robust finding, Duncan and Miller (2000) suggest that, to increase their effectiveness, therapists may attend to and work within "the client's theory of change." These findings and suggestions typically concern the adult client willingly attending therapy. This study investigated how they might apply to juvenile delinquents. The goal of the current study was to examine the relationship between working alliance and treatment outcomes with delinquent youth. In addition, it aimed to investigate an element of the working alliance suggested to be of particular importance to these youth, their perception that the treatment process "fits" their own theory of change. Given its impact on treatment of mandated clients, readiness for change was also examined for its relationship with working alliance and treatment outcomes. One hundred and fourteen incarcerated youth were asked to complete a series of surveys at baseline, 2-month, and 4-month follow-up. The relationship between the predictor variables (working alliance, readiness for change, treatment fit with change theory) and criterion variables (staff-rated treatment progress, rule violations, and predicted post-detention success) were examined with multiple regression. Results demonstrated that youths' baseline ratings of treatment fit with change theory predicted self-reported treatment progress 4 months later, even when controlling for readiness for change. Treatment fit with change theory was related to the working alliance in this sample, and was a better predictor of self-reported treatment gains than the working alliance. Results suggest that treatment fit with change theory may be a productive way to conceptualize the alliance construct in work with incarcerated youth. Qualitative data on theories of change was elicited from participants and content analyzed for themes. Contributions to the developing field of desistence theory and implications for clinical practice are discussed.