title: Do early therapeutic alliance, motivation, and stages of change predict therapy change for high-risk, psychopathic violent prisoners?
abstract: BACKGROUND
  Examination of the extent of offenders' engagement in change, and in rehabilitation programmes, is important to understanding success or failure following rehabilitation. In treatment programmes, the alliance between therapist and offender, and the therapy process itself appear central to progress offenders make that may reduce their criminal risk. But research with offenders seldom has measured therapeutic alliance and clinical writing suggests that it is difficult to form an alliance with those not ready to change their behaviour; especially with higher risk and psychopathic offenders.
  
  
  OBJECTIVE
  This study outlines the course of the therapeutic alliance in an 8-month treatment programme for high-risk, PCL-psychopathic violent prisoners. It examines relationships between early-treatment therapeutic alliance, therapists' global ratings of motivation to change, and initial stage of change on dynamic risk factors. In addition, it investigates which factors best predict who will complete treatment and change behaviourally during treatment.
  
  
  CONCLUSIONS
  In this challenging, high-needs client group, early-programme stage of change, therapists' perceptions of motivation, therapeutic alliance and psychopathy did not predict how much change prisoners made. Regardless of initial levels, prisoners whose alliance increased the most over the course of treatment made the most change.
authors.affiliation: Victoria University of Wellington, New Zealand. Devon.Polaschek@vuw.ac.nz
authors.forename: Devon L L
authors.initials: DL
authors.lastname: Polaschek
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ross
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology; D000987:Antisocial Personality Disorder / Q000523:psychology / Q000628:therapy*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D006801:Humans; D008297:Male; D009042:Motivation; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology*; D011329:Prisoners / Q000523:psychology*; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000379:methods*; D015203:Reproducibility of Results; D055502:Secondary Prevention; D014754:Violence / Q000517:prevention & control / Q000523:psychology*; D055815:Young Adult