The therapeutic alliance in sex offender treatment: The juxtaposition of violence and care.

Psychotherapy

April 2021

Full Citation

Aylwin, A. (2010). The therapeutic alliance in sex offender treatment: The juxtaposition of violence and care. ProQuest Dissertations Publishing.

Abstract

Group psychotherapy is the most widely utilized treatment modality for convicted

sex offenders, and the therapeutic alliance is considered a fundamental concept in

virtually all applications of psychotherapy. However, empirical examination of how the

therapeutic alliance impacts upon treatment effectiveness for sex offenders has been

neglected. In a prospective design, a sample of 95 consecutive admissions to an inpatient

treatment program for convicted adult male sex offenders was studied with regard to their

experience of the therapeutic alliance with treatment staff, with their copatients, and with

the overall treatment program. Patients of the Phoenix Program (Alberta Hospital

Edmonton) rated their sense of alliance at monthly intervals. The therapists who worked

with them (n = 21) also completed monthly evaluations of their own emotional responses

toward these same patients. Pre- to post-treatment comparisons on personality tests,

interpersonal distress, and interpersonal functioning showed a number of statistically

significant changes consistent with treatment goals. Patients’ self-report over time in

treatment showed a gradual, consistent increase of large effect size on all three alliance

targets. Sex offenders in this sample were able to experience positive alliance with

therapists and peers and the sense of alliance was shown to grow stronger over time. Staff

ratings revealed that positive and negative affect increased as patients’ time in treatment

increased. Significant associations between patient-rated alliance and outcome were

found to be positive and in desired directions. The growth rate in alliance toward

therapists was positively and significantly associated with the growth rate of “conflict

within oneself” among female therapists. Male therapists also reported significant growth

in “conflict within oneself” but this was independent of patient-rated alliance growth rates. Thus, female therapists experienced heightened affect in the face of greater patient

alliance, while male therapists also experienced heightened affect but for reasons

unrelated to patient alliance. There was virtually no reduction in negative affect toward

patients despite moderate increases in positive affect toward patients. This study

represents an important endorsement of a treatment model that seeks to improve general

adjustment and ameliorate risk factors associated with recidivism, via positive changes in interpersonal relationships