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Less directiveness by therapists improves drinking outcomes of reactant clients in alcoholism treatment.

Karno MP, Longabaugh R

Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA 90025, USA. karno@ucla.edu

In this study, the authors examined the impact of the interaction between clients' trait reactance and therapists' directiveness on the effectiveness of psychotherapy treatment for alcoholism. Ratings of videotaped treatment sessions were used to measure clients' reactance (N=141) and therapists' directiveness. Models tested for the interaction as a predictor of 1-year posttreatment drinking quantity and frequency. Results indicate that directiveness had a negative impact on outcomes for clients at medium and high levels of reactance but did not affect drinking among clients low in reactance. Increased therapist use of interpretation, confrontation, and introduction of topics was most predictive of more frequent and larger quantities of drinking among reactant clients. This study suggests that research on treatment process can yield significant theoretical and clinical benefits.

Published 30 March 2005 in J Consult Clin Psychol, 73(2): 262-7.
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