The Therapeutic Alliance in Substance Abuse Counseling From a Therapist’s Perspective: A Qualitative Phenomenological Study
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Authors
Rosedale, Jacob
Issue Date
2026-01
Type
Dissertation
Language
en
Keywords
Therapeutic Alliance Addiction , Healthcare Innovation & Delivery
Alternative Title
Abstract
Substance use disorder poses a global public health challenge, with treatment dropout and relapse often undermining long-term recovery. A key predictor of successful outcomes in addiction treatment is the therapeutic alliance, but the specific therapist behaviors that foster and sustain a strong relationship, particularly in the context of substance abuse treatment, are not well-defined. This study explores strategies and the behaviors used to establish, develop, and maintain the alliance in substance use counseling, guided by self-determination theory. The population of interest included addiction treatment clients at risk for disengagement and professionals seeking effective engagement strategies. A qualitative methodology was employed using Interpretative Phenomenological Analysis to explore the lived experiences of 15 licensed addiction counselors practicing in Israel. Data were collected through semi-structured interviews and analyzed using a six-stage coding process to identify relevant themes. Findings highlighted the importance of authentic presence, empathic connection, transparency, and emotional safety during initial sessions. Long-term maintenance of the alliance was supported by relational consistency, validation of effort, and autonomy-supportive behaviors that respected client pacing and agency. These results indicate that the therapeutic alliance is not merely a byproduct of effective treatment but a critical mechanism for promoting recovery. This study contributes to the literature by operationalizing relational behaviors aligned with the psychological needs of relatedness, autonomy, and competence. Implications include prioritizing relational skill development in therapist training programs and examining how these behaviors influence client outcomes across diverse populations and treatment contexts.