Strengthening the Working Alliance for Clients With Substance Use Disorders and Child Maltreatment Histories

Individuals seeking treatment for substance use disorders frequently have child maltreatment histories. These clients often present with a unique set of characteristics, which may interfere with treatment retention and treatment engagement. A strong working alliance protects against premature discontinuation of counseling services and is a strong predictor of positive outcomes in counseling. Individuals with a history of child maltreatment are more likely to present with characteristics that can interfere with the counseling working alliance. This study assessed the relationships among maltreatment severity, emotion regulation, length of treatment time, and interpersonal trust in a clinical sample of adults receiving residential treatment for a substance use disorder who also met criteria for child maltreatment (n = 113). Results suggest that emotion regulation and trust significantly relate to the counseling working alliance, but only trust significantly and uniquely contributed to the regression model. Included are trauma-informed counseling recommendations for assessment of maltreatment and interventions to enhance trust and the working alliance.