This study examined the relationship between supervisee attachment orientation, rapport of the supervision working alliance over time, the change of supervisee attachment orientation, and the perceived impact of supervision on the lives of the supervisees. Participants were 117 master?s level counseling student at the entry (34), practicum (45), and internship (38) levels, counseling clients with supervision. This study used the Relationship Questionnaire and the Rapport score from the Supervision Working Alliance Inventory. Data was collected via e-mail at the beginning, middle, and end of the semester. Data was examined using Two-Way Factorial ANOVAs, Bowker Tests, and Chi-Square Tests. There were statistically significant changes in attachment orientation over time, and a statistically significant relationship between working alliance rapport scores and supervisee attachment. A change in attachment from preoccupied and fearful toward secure and dismissing orientations occurred. These findings may indicate the importance of considering attachment in the supervision relationship.

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Over the past three decades, the United States criminal justice system and mental health treatment providers have collaborated in ways to support more than 20.3 million individuals who are struggling with a substance use disorder (SUD), and who may also be facing drug-related offenses due to their ongoing challenges combatting addiction. Through collaborative efforts we have been fortunate to witness the establishment of adult drug treatment courts, as well as other problem-solving court processes. With more than 1,500 active adult drug treatment court programs in this country, there is a critical need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. Adult drug treatment court programs have been shown to have discrepant success outcomes (8% to 80%) in terms of reducing criminal recidivism; moreover, the existing literature examining the lived experiences of participants in these programs is both minimal and disheartening. This lack of empirical data is problematic for the counseling profession given that they serve as key change agents in this process. What we do know is that the process of creating treatment goal and modalities, which should be in the hands of the clients and their counselors, can be complicated by court-mandated requirements. This bi-level structure has the potential to create ruptures in the working alliance between clients and counselors providing SUD treatment to this population. Accordingly, additional research is needed to explore the client experience within the working alliance, and in so doing reveal the influences at play when working with clients who are mandated to receive SUD treatment. This qualitative study was guided by one central research question: How do clients experience the working alliance with counselors during drug court-mandated addictions treatment? Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients. / Doctor of Philosophy / With more than 1,500 active drug court programs throughout the United States, there is a pressing need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. While adult drug treatment court programs have been shown to have positive outcomes in terms of reducing criminal recidivism, the existing literature examining the participants' lived experiences receiving SUD treatment is minimal and disheartening. Due to the nature of the mandated treatment relationship, the confidentiality which has historically bound and secured the therapeutic working alliance is less defined than it is in fully voluntary treatment settings. This shift in understanding what creates a healthy working alliance for mandated clients to work through presenting treatment issues is something that has yet to be explored by current research. The current study sought to explore clients' experiences of the working alliance with counselors during drug court-mandated addictions treatment. Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients.

Private community-based mental health agencies fill a vital role in Virginia's health system in that they increase access to care and provide a wide range of services. In order to operate and receive state funding, these private agencies are responsible for abiding by regulations set forth by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Medical Assistance Services (DMAS). Supervision, as defined by DBHDS and DMAS, features a more administrative approach, requiring supervisors to review policies and ensure procedural compliance. In contrast, supervision as defined by counselor educators leans more towards a clinical approach whereby a more experienced member of the profession will guide the supervisee in professional development through the enhancement of skills and techniques. The issue of interest herein is that little is known about how supervisors in private community-based mental health agencies are navigating these multiple areas of supervisory emphasis. This quantitative inquiry focused on understanding clinicians' perceptions of supervision emphasis and its influence on the supervisory relationship in private mental health agencies in Virginia. Three research questions were developed to determine (a) the influence of clinicians' perceptions of supervision emphasis on the supervision working alliance, (b) the relationship between a supervisor's licensure status (Licensed Professional Counselor versus other designations) and the influence on the supervisory working alliance, and (c) the influence of supervisor responsibilities of hiring/terminating staff and/or conducting performance evaluations on the working alliance. Instruments used in this study included a demographic questionnaire, the Supervisor Emphasis Rating Form-Revised (SERF-R), and the Working Alliance Inventory-Revised (WAI-R). Analysis methods utilized in this study included multiple regression, T-tests, and analysis of variance. Three key findings emerged from this investigation. The first finding is that multiple regression results showed that the professional behaviors mean score in the SERF-R could explain 13% of variance in the WAI-R. The second key finding is that supervisors with the credential of Licensed Professional Counselor had a higher mean working alliance score than those with other professional licensures. The final key finding is that there was no significant difference in the working alliance between clinicians whose supervisors were responsible for certain administrative tasks and those clinicians whose supervisors had no such responsibilities. The implications of this study, its limitations, and suggestions for future research are detailed herein. / Ph. D.

Background: attachment theory provides an account of human behaviour across the lifespan, has a strong theoretical foundation and is clinical applicable. It is particularly relevant to older adults, who are often exposed to a greater number of losses. Despite a growing awareness of increasing life expectancy worldwide, services for older adults in the NHS remains under-resourced. However, increased exposure to death and loss in the work might result in clinical psychologists being more reluctant to choose this specialism and may raise issues about their own early attachment experiences. Therefore, it is important to understand how clinical psychologists approach the complexities of their work in light of their own early attachment experiences. Qualitative research of the lived experiences of clinical psychologists is sparse and to date there are no studies addressing this specific issue. Aims: this is an exploratory study which addresses a gap in the literature. The aims are to capture the early attachment experiences of clinical psychologists specialising in working with older adults. It is hoped that the outcome of the study will shed some light on the characteristics of this under-researched group and how they manage the challenges of the work. Methodology: a semi-structured interview schedule was developed to explore how clinical psychologists make sense of their work with older adults in light of their early attachment experiences. Interviews were carried out with five clinical psychologists working in specialist older adult services. The transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: the analysis of the five interviews yielded five main themes – “Making sense of early attachment relationships”, “Developing identity in childhood and adolescence”, “Understanding of decision to work with older adults”, “Work with older adults as both challenging and rewarding” and “The person within the professional”. Each of the main themes and their subthemes were supported by excerpts from narratives of participants experiences. Implications: this study highlighted several research and clinical implications. First, the role of non-parental childhood attachments in the development of internal working models is currently an under-researched area which may provide important insights into resilience factors in the face of childhood adversity. Second, clinical implications suggest that access to older adult work early on in the career of clinical psychologists may increase desirability of working in specialist services. Third, the study supports attachment theory as a useful approach to understanding the work with older adults and as a valuable area for the professional development of clinical psychologists. Finally, systemic working with older adults remains an important part of the work which would benefit from further research in this area.

The purpose of this research was to determine if a relationship exists between quality of the therapeutic working alliance and counselors' and clients' Adlerian personality priorities. Variables included counselors' and clients' Adlerian personality priorities and ratings of working alliance. Information for counselors' and clients' Adlerian personality priorities was obtained on the Allen Assessment for Adlerian Personality Priorities (AAAPP; Allen, 2005). Working alliance was measured with the Working Alliance Inventory- short revised (WAI-SR; Hatcher & Gillaspy, 2006). Participants included 14 counselors and 31 clients from a community counseling clinic on a university campus in the southwest United States. Results suggested that match between counselors' and clients' Adlerian personality priorities is related to counselors' perceptions of quality of the therapeutic working alliance. Statistically significant values were found on one hypothesis, as well as large effect sizes.

Given the importance of client characteristics and preferences, and therapist expertise to evidence-based practice in psychology, the current study sought to contribute to the literature concerning the role of values in psychotherapy. Personal values of clients and trainee therapists in 29 dyads were examined for relationships between client and therapist values and associations with working alliance and outcomes. Although previous literature in this area has suggested that successful therapy is characterized by an increase in similarity of client and therapist values, the current study did not replicate this finding. However, client perceptions of therapist values were found to be important to working alliance and outcome. Findings are discussed in terms of suggestions for future research as well as implications for clinical practice, including the importance of discussing expectations and preferences with clients.

BACKGROUND In recent years, there has been a push to measure and monitor the quality of health care and the delivery of effective services. Substance use disorders are debilitating and in order to better understand this facet of substance abuse, it is important for organizations and providers to assess the quality of services, client satisfaction, and the relationships that exist between clients and treatment providers. PURPOSE The purpose of the study was to (1) assess the extent of the relationship between measures of client perceptions of satisfaction and treatment outcomes and (2) to assess the relationship between measures of therapeutic alliance and treatment outcomes. METHODS Data was obtained from a larger study assessing organizational factors affecting the implementation of evidence-based practices in the treatment of substance use disorders. This study was focused on the client satisfaction survey data obtained during the months of August and December of 2008, consisting of several five-day periods, during which clients were asked to complete the survey. The study population consisted of 371 clients aged 18 to 64 years. Logistic regression was used to evaluate demographic and other substance use-disorder factors for each of the scales pertaining to client satisfaction (general satisfaction, access, and quality/appropriateness) and therapeutic alliance (bond, goal, and task) in order to obtain odds ratios and 95% confidence intervals. Pearson correlation coefficients were used to assess the strength of the relationship of each of the measures of client satisfaction and therapeutic alliance with client perceived outcomes. Due to the nature of the survey questions being adapted from validated measures, Cronbach's coefficient alphas were used to determine internal consistency and reliability within each of the scales. To further assess client measures of satisfaction, multivariate linear regression was used to examine whether a specific client satisfaction measure or therapeutic alliance measure was a significant predictor of better client perceived outcomes. RESULTS Client perceptions of satisfaction - general satisfaction, access, and quality/appropriateness (worse vs. better) were significantly associated with better client perceived outcomes. Therapeutic alliance measures were also significantly associated with better client perceived outcomes. The strongest predictors from logistic regression analysis were quality/appropriateness (OR = 14.45, 95% CI 1.16-19.01) and general satisfaction (OR = 11.96, 95% CI 7.04-20.33) followed by WAI Goal (OR = 5.56, 95% 3.29-9.39), access (OR = 5.81, 95% CI 3.55-9.50), WAI Task (OR = 4.42, 95% CI 3.29-9.39), and WAI Bond (OR =3.61, 95% CI 2.06-5.22). Cronbach's coefficient alphas were all above the .70 threshold indicating strong internal consistency among the measures of client satisfaction, therapeutic alliance and client perceived outcomes. Pearson correlation coefficients indicated moderate relationships between access, general satisfaction, WAI Bond, Goal and Task with client perceived outcomes. The strongest correlation was that of quality/appropriateness of treatment services and client-perceived outcomes (r = 0.61, p<0.0007) CONCLUSIONS Client perceptions of satisfaction and therapeutic alliance were found to be significantly associated with better client perceived outcomes. Age, time in treatment, and number of times a client moved in the past 6 months was implicated in the association of general satisfaction and better client perceived outcomes. Age and race were implicated in the association of access and better client perceived outcomes. Further research is needed to measure the effectiveness of treatment services to ensure that clients are receiving appropriate evidence-based services that result in better outcomes.

Supervisors are largely responsible for the structuring of supervision in counseling, which is influenced by various factors pertaining to a supervisor, all of which greatly affect the development of the counselor trainee. This study was designed to explore the factors of attachment styles, self-efficacy for giving corrective feedback and the dimensions of the working alliance. The results will ultimately inform counselor educators and supervisors about the practice of supervision and the implications of supervisors’ attachment styles in counselor supervision.