Kember, TC; (2013) The relationship between alliance, adherence, and attendance when using a contingency management intervention in opiate substitution therapy. Doctoral thesis , UCL (University College London).

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Abstract

This volume consists of three parts. Part 1, the literature review, examines 20 papers to describe the current understanding of the relationship between therapist alliance, therapist adherence and outcome in individual psychotherapy. Part 2, the empirical paper, uses data from participants in the Positive Reinforcement targeting Abstinence In Substance misuse (PRAISe) randomised control trial being conducted in south east England. This trial investigates the effectiveness of contingency management (CM) interventions in opiate substitution therapy to improve attendance and abstinence of heroin. The paper explores the impact of CM interventions on levels of attendance in opiate substitution therapy and investigates the relationship between client factors, therapeutic alliance, therapist adherence to the CM and levels of attendance. Part 3, the critical appraisal, is in two sections. The first section explores the debate between research that attributes therapeutic outcome to factors that are common across different types of psychotherapy such as the therapeutic alliance, and research that highlights the importance of the contribution of theory specific interventions, measured by therapist adherence. The second section considers some of the moral and ethical concerns about using incentives in health care and some of the implications for future research and clinical practice.

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