The Relation Between the Working Alliance on Mental Illness and Criminal Thinking Among Justice-Involved People With Co-Occurring Mental Illness and Substance Use Disorders

What is the public health significance of this article? These findings expand our understanding of the role of the working alliance in treatment change among a criminal justice-involved clinical sample with mental illness and substance use disorders. Clinicians should continue to focus on not only treatment needs but also treatment processes for people with mental illness, regardless of setting. Objective: The therapeutic working alliance is an important factor in producing treatment change and positive therapeutic outcomes for people with mental illness, yet little is known about the working alliance's role in treatment change in people with mental illness that is justice involved. In addition to treating the mental illness symptoms of justice-involved people with mental illness, addressing factors known to predict criminal behavior (including criminal thinking) could optimize posttreatment outcomes and reduce future justice involvement. This study examines the role of the working alliance in treatment change in a clinical treatment sample of 265 adult male and female justice-involved people with mental illness and substance use disorders completing probation sentences in a residential treatment facility. Method: Repeated measures moderation analyses were used to test participants' reported working alliance as a moderator of change from pre- to posttreatment scores of self-reported mental illness symptoms and criminal thinking. Results: The working alliance significantly moderated reductions in depression, anxiety, anger, and manic symptoms (R (2) ranging from .03 to .09), and general, reactive, and current criminal thinking (R (2) ranging from .04 to .11). Conclusions: These findings expand the literature on the relation between working alliance and changes in mental illness symptoms by testing this association in the understudied population of justice-involved people with mental illness; these results also suggest the working alliance is associated with changes in criminal thinking. Treatment providers working with justice-involved people with mental illness should assess and emphasize the development of a working alliance to maximize treatment change.