Author: Jacob Rosedale, PhD, LPC (affiliation National University, Bellevue University) Abstract Autonomy support has emerged as a critical yet under-specified component of effective addiction treatment. Although motivational and alliance-based frameworks emphasize the importance of client agency, the field has offered limited guidance regarding how autonomy is communicated in real-time clinical interactions, particularly during early treatment sessions. This article examine

The therapeutic alliance is one of the most reliable predictors of engagement and treatment outcome across psychotherapies, yet its role becomes especially consequential in substance use disorder (SUD) treatment, where ambivalence, shame, and fluctuating motivation are common. This integrative review synthesizes contemporary alliance research, process-outcome findings, and motivational science to clarify how relational mechanisms function as active ingredients in addiction tr

Author: Rosedale, Jacob PhD, LPC Jacob Rosedale Therapy, Independent Clinical Practice, Ramat Beit Shemesh, Israel National University, Department of Psychology, San Diego, California, USA Abstract Substance use disorder (SUD) treatment continues to face challenges related to engagement, early dropout, and inconsistent long-term outcomes. Although the therapeutic alliance is one of the most reliable predictors of success across treatment modalities, far less is known about th

The therapeutic alliance is widely recognized as a central mechanism of change in psychotherapy, yet in addiction treatment it is frequently subordinated to technique, compliance, and procedural efficiency. Despite extensive empirical support linking alliance quality to engagement, retention, and outcomes, clinical training and institutional practices often constrain the relational conditions necessary for effective treatment.

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