A HEALING JUSTICE: Therapeutic alliance on the NSW Drug Court

Abstract

People with a drug use disorder are disproportionately represented in the criminal justice system and there is a critical need for effective treatments for this population. The Drug Court is the most prominent, well-established and effective diversion intervention program worldwide for people with a drug use disorder who have offended. Despite this, we have limited understanding of how each component of the Drug Court contributes to both individual outcomes and overall program success and quality. With emerging evidence of the crucial role of psychological therapy in positive Drug Court outcomes, there is a critical need to explore the mechanisms that underpin successful psychological treatment within a Drug Court program so as to optimise treatment processes.

Underlying the effectiveness of psychological therapy is the alliance between therapist and client. There is consistent evidence in the broader literature that the strength of therapeutic alliance contributes more to positive treatment outcomes than the specific treatment intervention. However therapeutic alliances that unfold within a legally coerced treatment framework such as the Drug Court face unique constraints. Despite the prominence of the Drug Court globally and the crucial role psychological treatment has been found to play in client outcomes, there has been no investigation of the role of therapeutic alliance in outcomes for those participating in the Drug Court. This thesis addresses this substantial gap in literature through four world-first empirical studies designed to rigorously investigate the role of the therapeutic alliance within the broader context of treating people with drug use disorders and then more specifically within a Drug Court program. A critical realism research paradigm framed this thesis and is used to elucidate the ways in which setting, context and wider social forces impact upon therapeutic relationships.