Client characteristics associated with early therapeutic alliance in a drug court program

J Subst Use Addict Treat. 2026 Apr 27:209995. doi: 10.1016/j.josat.2026.209995. Online ahead of print.

ABSTRACT

INTRODUCTION: Drug court programs are one of the most prominent interventions for people with a drug use disorder who have offended, and there is emerging evidence of the crucial role psychological therapy plays in achieving optimised program outcomes. The therapeutic alliance between therapist and client underpins effective psychological treatment in a range of mental health disorders, including drug use disorders. Little is known, however about the forging of a therapeutic alliance when delivered treatment is delivered within a legal framework such as a drug court program. This is the first study to examine the role client characteristics play in the development of the therapeutic alliance in the early stages of a drug court program.

METHOD: The study collected data from 93 participants who had commenced the New South Wales Drug Court in Australia was collated and examined relationships between client characteristics and strength of the early therapeutic alliance.

RESULTS: Motivation to change drug use was associated with a stronger early therapeutic alliance with therapist. A history of exposure to trauma in childhood negatively impacted upon the strength of early alliance.

DISCUSSION: Individual client characteristics influence early therapeutic alliance when treatment is delivered within a legal framework. Recommendations for clinical practice are provided which will build therapist responsivity to individual client needs when forming a therapeutic relationship in the early days of a drug court program.

PMID:42055164 | DOI:10.1016/j.josat.2026.209995