Trust the therapists' trust: working alliance development in relation to treatment attendance and completion in intimate partner violence perpetrator group therapy

Objective: Intimate partner violence perpetrator (IPV) treatment interventions are traditionally associated with large dropout and low treatment adherence. Perceived working alliance is a proven predictor of treatment adherence and completion.

Methods: We measured patient (N = 199) and therapist (N = 30) working alliance after every treatment session during an 18-session cognitive behavioral group therapy for IPV perpetrators. We hypothesized that patient and therapist working alliance ratings would be strongly correlated and that both patient and therapist working alliance would be positively related to session attendance and treatment completion.

Results: Patient and therapist working alliance ratings remained fairly stable during the course of treatment and patients and therapists moderately agreed on their perception of their working alliance. The therapists' judgment of the working alliance strongly predicted session attendance and treatment completion, whereas the patients' working alliance ratings did not predict attendance nor completion. In line with previous studies, patients' age was positively associated with both session attendance and treatment completion.

Conclusion: The findings clearly indicate the importance of a positive working alliance from the start of group IPV perpetrator treatment, and that therapists should be on the alert if they perceive the working alliance as suboptimal because it predicts poorer attendance and dropout.