NU671 Unit 9 Alliance With a Court-Mandated Client Example

"I'm Only Here Because the Judge Said So": A Therapeutic Alliance Paper on Building Goals, Tasks and a Bond With a Court-Mandated Client After a Second DUI

[Student Name]

Purdue University Global

NU671: PMHNP Psychopathological Disorders and Psychotherapy

Unit 9 Therapeutic Alliance Paper

[Instructor Name]

[Date]

The client is composite; details and scores are bracketed.

The Client and the Problem

Mr. [W.] is a [42]-year-old roofing foreman with two children. He was arrested for driving under the influence for the second time in [four] years, with a blood alcohol concentration of [0.14]. The court ordered [12] sessions of outpatient treatment as a condition of keeping a restricted license. He drinks [six to eight] beers most evenings and more on weekends. He does not see himself as having a problem; he sees himself as having been unlucky. In the first session he sat with his arms crossed and said, "I'm only here because the judge said so. I'll come, but don't expect me to spill my guts."

A mandated client presents a particular challenge for the therapeutic alliance. He has not chosen treatment, he does not share the therapist's view of what is wrong, and the therapist is, in his eyes, part of the system that is punishing him.

Why the Alliance Matters Here

The therapeutic alliance is one of the most consistently supported predictors of outcome in psychotherapy. Pooling research on well over [30,000] psychotherapy patients, Flückiger and colleagues estimated the alliance-outcome correlation at roughly [0.28], robust across treatment approaches, measures, rater perspectives and patient characteristics (Flückiger et al., 2018). The association does not prove that a better alliance causes a better outcome, but it is strong enough that neglecting the alliance with a reluctant client would be a serious error.

Bordin's Three Components

Bordin described the working alliance as three elements: agreement on the goals of treatment, agreement on the tasks that will achieve them, and the bond between client and therapist (Bordin, 1979). With most voluntary clients, the three develop together. With Mr. [W.], they have to be built in a particular order. A client who does not want to be here cannot be asked to trust the therapist first; he can be asked to agree on something small first.

Goals: Finding One He Shares

The therapist did not begin with the goal of reducing drinking, which Mr. [W.] did not share. Instead, the therapist asked what he wanted from the next [12] weeks. His answer was clear: to finish the sessions, keep his license and avoid a third arrest, which would cost him his job. That goal, avoiding a third arrest, became the first agreed goal. It was not the therapist's ideal goal, but it was genuine, and it opened a door: what would have to be true to make a third arrest impossible?

Motivational interviewing provided the approach for these conversations. It avoids arguing with the client about whether he has a problem and instead elicits his own reasons for change. Across more than a hundred studies, motivational interviewing has shown small but reliable effects on substance use and related outcomes, often in fewer sessions than other treatments (Lundahl et al., 2010).

Tasks: Making the Work Make Sense to Him

Tasks were chosen that fit his goal. The therapist asked him to track his drinks and his driving for one week, not to prove he drank too much but to see how often drinking and driving came close to overlapping. He agreed, because it fit the goal of avoiding another arrest. The record showed [three] evenings when he drove home from a job site after drinking with his crew. Seeing this on paper, he said, "That's closer than I thought."

In session four the tasks expanded: planning rides home on crew nights, and an experiment in which he limited himself to [two] beers on two evenings to see how he felt the next morning.

The Bond: Earned, Not Assumed

The bond was not forced. The therapist was honest about the court arrangement: attendance would be reported, and nothing else without his consent. She respected his skepticism, used his language rather than clinical terms, and acknowledged the real costs of the mandate, including the drive and time off work. By session five he arrived without crossed arms and asked whether his brother, who "drinks worse than me," could come to a session.

Tracking the Alliance

The alliance was measured after each session with the short revised version of the Working Alliance Inventory, a [12]-item self-report scale that measures goals, tasks and bond (Hatcher & Gillaspy, 2006). His total scores, out of [60], were:

1. Session one: [24]; goals [7], tasks [9], bond [8].

2. Session two: [30].

3. Session three: [34].

4. Session four: [29]; after the therapist raised reducing drinking directly, before he was ready.

5. Session five: [40].

6. Session six: [44]; bond [15].

The dip in session four was a rupture. The therapist had moved to her own goal before his, and he rated the goals subscale lower. She named it in session five: "Last time I pushed for something you hadn't signed up for. That's on me." He accepted this, and the score recovered. Tracking the alliance made the rupture visible when it might otherwise have been missed, since he had not complained.

What the Therapist Avoided

Several common moves were deliberately avoided, because each would likely have damaged the alliance with this client. The therapist did not open with a standardized alcohol screen read aloud item by item, which can feel like an interrogation to someone who already feels judged. She did not label him an alcoholic or insist that he accept a diagnosis before any work could begin. She did not argue when he minimized the arrests, and she did not threaten to report poor engagement to the court. She also avoided the opposite mistake of pretending the mandate did not exist; naming it openly in the first session made her more credible, not less. Each of these choices protected agreement on goals and tasks, which in turn gave the bond room to form.

Limits and What the Paper Does Not Claim

The paper does not claim that the alliance changed his drinking. His drinking had fallen modestly by session six, but many other factors, including the threat of losing his job, were at work. The alliance-outcome association is correlational, and a single case cannot establish cause. What the case does show is that an alliance can be built with a mandated client, that it can be tracked with a brief tool, and that building it in the order of goals, tasks and bond made each step possible.

References

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252-260. https://doi.org/10.1037/h0085885

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340. https://doi.org/10.1037/pst0000172

Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy Research, 16(1), 12-25. https://doi.org/10.1080/10503300500352500

Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137-160. https://doi.org/10.1177/1049731509347850