An examination of how therapist directiveness interacts with patient anger and reactance to predict alcohol use.
OBJECTIVE
This study examined the interactions of therapist directiveness with patient anger and patient reactance among an alcohol-treatment-seeking sample.


METHODS
Participants in the study consisted of 139 individuals with alcohol abuse or dependence who received treatment at a single clinical research unit of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Analyses tested for the independence of the two interactions, identified components within the directiveness construct and examined the relationship between those components and the patient attributes.


RESULTS
Results showed that the interactions between directiveness and anger and between directiveness and reactance each accounted for unique variance in predicting posttreatment alcohol use as measured by percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD). Principal components analysis of the directiveness construct generated two underlying components that were interpreted to be confrontation and structure. Significant interactions were observed between patient reactance and both the confrontation and structure components. Confrontation also interacted with patient anger; however, no interaction was found between anger and structure.


CONCLUSIONS
The interactions of therapist directiveness with patient anger and reactance demonstrated both shared and unique qualities. These results highlight the importance of focusing on specific aspects of directiveness to better understand the effect of patient-treatment interactions on alcohol use. This study has implications for theory and research as well as for the delivery of treatment services.
Karno
Mitchell P
MP
University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, California 90025, USA. karno@ucla.edu
Longabaugh
Richard
R
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000628:therapy*; D000553:Ambulatory Care; D000786:Anger; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010361:Patients / Q000523:psychology*; D015995:Prevalence; D011369:Professional-Patient Relations; D011446:Prospective Studies; D014743:Videotape Recording