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The impact of counselor recovery status, disclosure, education, and experience on the working alliance in the treatment of substance use disorders

Dissertation
Author: Brian D. Roland
Abstract:
Although evidence shows that between 30 and 75 percent of alcohol and other drug (AOD) counselors are themselves in recovery from a substance use disorder, dated research comparing the effectiveness of recovering and non-recovering counselors failed to control for education, experience, and use of disclosure. Given that the strength of the working alliance between client and counselor is highly predictive of outcome and utilizing interpersonal influence theory as an organizing framework, a path model was hypothesized which posited (a) counselor recovery status and its disclosure impact counselor attractiveness which, in turn, impacts working alliance; (b) counselor education impacts counselor expertness which, in turn, impacts working alliance; and (c) counselor experience impacts counselor trustworthiness which, in turn, impacts working alliance. To test this model, a causal comparative/ex post facto design was used. Participants included 31 AOD counselors and 180 clients receiving inpatient and residential treatment for a substance use disorder. Counselor recovery status, disclosure, education, and experience were collected using forms designed by the investigator. Counselor attractiveness, expertness, and trustworthiness were assessed with the Counselor Rating Form-Short, while working alliance was assessed with the Working Alliance Inventory. Data were collected from seven inpatient and residential programs in Albany, New York. A path analysis was done using a series of multiple regression analyses. Recovery status and education had significant indirect effects on working alliance. Specifically, counselors in recovery were perceived as significantly more attractive to clients and those perceived as more attractive had a significantly stronger working alliance (B = 1.992, p < .05). Likewise, more educated counselors were perceived as more expert to clients and those perceived as more expert had a significantly stronger working alliance (B = 2.434, p < .01). Experience and disclosure had neither significant direct nor indirect effects on working alliance. This investigation demonstrates the impact of counselor recovery status and education on working alliance. A chief limitation is the lack of control for other client variables that also affect working alliance, including quality of current and past relationships and counselor gender. Nevertheless, a key theoretical implication is that counselor recovery and education are not sufficient to impact working alliance; a client must perceive these things. Consequently, a key practice implication is that both recovering and non-recovering counselors can promote a stronger working alliance by identifying and utilizing skills that enhance a client's perception of expertness and attractiveness. Future research must take into account counselor recovery status and education when studying the effects of counselor characteristics on treatment outcomes.

vi Table of Contents

Abstract ............................................................................................................................. ii

Acknowledgments............................................................................................................ iv

List of Tables .....................................................................................................................x

List of Figures .................................................................................................................. xi

Chapter I. Introduction .......................................................................................................1

Statement of the Problem ..........................................................................................2 Purpose of the Study .................................................................................................3 Significance of the Study ..........................................................................................4 Interpersonal Influence Theory .................................................................................5 Impact of Recovery Status on Client Perceptions of Counselor ...............................8 Impact of Recovery Status on Client Treatment Outcomes....................................15 Impact of Education on Client Outcomes ............................................................... 19 Lack of Control for Years of Education ................................................................. 22 Impact of Counselor Experience on Client Treatment Outcomes .......................... 25 Lack of Control for Counseling Experience ........................................................... 29 Lack of Knowledge of Recovering Counselor Disclosure ..................................... 31 Statistics on Disclosure Utilization by Helping Professionals ................................ 31 Positive Impact of Disclosure ................................................................................. 31 Impact of Disclosure on Participants’ Perceptions of Social Attraction................. 35 Impact of Disclosure of Similarity on Participants’ Perceptions ............................ 38 Conclusions ............................................................................................................. 41 Research Questions and Hypotheses ...................................................................... 42

vii Chapter II. Methodology .................................................................................................. 47 Research Design...................................................................................................... 48 Internal Validity of the Study ................................................................................. 48 Sampling Plan ......................................................................................................... 50 Power Analysis ....................................................................................................... 52 Participants .............................................................................................................. 52 Measures ................................................................................................................. 55 Counselor Recovery Status ......................................................................... 61 Counselor Education and Experience ......................................................... 61 Counselor Disclosure .................................................................................. 62 Statistical Methods .................................................................................................. 62 Human Subjects Issues ........................................................................................... 66 Procedures ............................................................................................................... 67 Chapter III. Results .......................................................................................................... 69 Descriptive Statistics ............................................................................................... 70 Correlations ............................................................................................................. 73 Path Analysis .......................................................................................................... 78 Counselor Recovery Status ......................................................................... 83 Counselor Education ................................................................................... 83 Counselor Experience ................................................................................. 84 Counselor Disclosure .................................................................................. 85 Chapter IV. Discussion .................................................................................................... 87 Discussion of Results .............................................................................................. 88

viii Counselor Recovery Status ......................................................................... 88 Counselor Education ................................................................................... 91 Counselor Experience ................................................................................. 93 Counselor Disclosure .................................................................................. 94 Hypotheses .............................................................................................................. 96 Limitations ............................................................................................................ 100 Conclusions ........................................................................................................... 102 Implications for Theory ........................................................................................ 104 Implications for Research ..................................................................................... 106 Implications for Practice ....................................................................................... 108 References ...................................................................................................................... 109 Appendix A: Counselor Demographic Questionnaire ................................................. 125 Appendix B: Client Demographic Questionnaire ........................................................ 128 Appendix C: Agency Director Phone Script ............................................................... 130 Appendix D: Facility Permission Letter ...................................................................... 132 Appendix E: Research Flyer ....................................................................................... 134 Appendix F: Counselor Consent Form ....................................................................... 136 Appendix G: Counselor ID Form ................................................................................ 138 Appendix H: Client Consent Form .............................................................................. 140 Appendix I: Consent for Release of Confidential Information Form ........................ 142 Appendix J: Univariate Outlier Results Using Standardized Box Plots for ExpertZ, TrustworthyZ, AttractiveZ, and WAIz ................................... 144

ix Appendix K: Normality Results Using Histograms for Education, Experience, Expert, Trustworthy, Attractive, WAI, Readiness to Change, and Number of Sessions ............................................................................... 147 Appendix L: Linearity Results Using Bivariate Scatterplots between Pairs of Continuous Variables in the Path Model ............................................... 152 Appendix M: Homoscedasticity Results Using Standardized Scatterplots between Pairs of Continuous Variables in the Path Model.................... 158

x List of Tables Table I: Demographic characteristics of counselors .................................................. 54 Table II: Demographic characteristics of clients ......................................................... 55 Table III: Mean, standard deviations, skewness, kurtosis, and cronbach’s alpha for CRF-S, WAI, and URICA measures .......................... 64 Table IV: Descriptive statistics of counselors .............................................................. 71 Table V: Descriptive statistics of clients ..................................................................... 72 Table VI: Zero-order correlation coefficients among ten variables in the path model .............................................................................................. 74 Table VII: Unstandardized and standardized regression weights .................................. 81 Table VIII: Unstandardized direct, indirect, and total effects ......................................... 84

xi List of Figures

Figure 1: A path diagram with the interpersonal influence theoretical (IIT) framework .............................................................................................. 7 Figure 2: Path (structural) model ................................................................................. 53 Figure 3: Full path model with beta (ß) coefficients .................................................... 80 Figure J1: Univariate outlier result using a standardized box plot for expertZ ........... 144 Figure J2: Univariate outlier result using a standardized box plot for trustworthyZ .. 144 Figure J3: Univariate outlier result using a standardized box plot for attractiveZ ...... 145 Figure J4: Univariate outlier result using a standardized box plot for WAIz .............. 145 Figure K1: Normality result using a histogram for education ...................................... 147 Figure K2: Normality result using a histogram for experience .................................... 147 Figure K3: Normality result using a histogram for expert ............................................ 148 Figure K4: Normality result using a histogram for trustworthy ................................... 148 Figure K5: Normality result using a histogram for attractive ....................................... 149 Figure K6: Normality result using a histogram for WAI .............................................. 149 Figure K7: Normality result using a histogram for readiness to change ...................... 150 Figure K8: Normality result using a histogram for number of sessions ....................... 150 Figure L1: Linearity result using a bivariate scatterplot between education and the WAI ............................................................................................... 152 Figure L2: Linearity result using a bivariate scatterplot between experience and the WAI ............................................................................................... 152 Figure L3: Linearity result using a bivariate scatterplot between expert and the WAI ............................................................................................... 153

xii List of Figures (continued) Figure L4: Linearity result using a bivariate scatterplot between trustworthy and the WAI ............................................................................................... 153 Figure L5: Linearity result using a bivariate scatterplot between attractive and the WAI ............................................................................................... 154 Figure L6: Linearity result using a bivariate scatterplot between readiness to change and the WAI ............................................................................... 154 Figure L7: Linearity result using a bivariate scatterplot between number of sessions and the WAI ................................................................................. 155 Figure L8: Linearity result using a bivariate scatterplot between education and expert ................................................................................................... 155 Figure L9: Linearity result using a bivariate scatterplot between experience and trustworthy ........................................................................................... 156 Figure M1: Homoscedasticity result using a standardized scatterplot between education and the WAI. .............................................................................. 158 Figure M2: Homoscedasticity result using a standardized scatterplot between experience and the WAI ............................................................................. 158 Figure M3: Homoscedasticity result using a standardized scatterplot between education and expertness ............................................................................ 159 Figure M4: Homoscedasticity result using a standardized scatterplot between experience and trustworthiness................................................................... 159 Figure M5: Homoscedasticity result using a standardized scatterplot between expertness and the WAI.............................................................................. 160

xiii List of Figures (continued) Figure M6: Homoscedasticity result using a standardized scatterplot between trustworthiness and the WAI ...................................................................... 160 Figure M7: Homoscedasticity result using a standardized scatterplot between attractiveness and the WAI ......................................................................... 161 Figure M8: Homoscedasticity result using a standardized scatterplot between readiness to change and the WAI ............................................................... 161 Figure M9: Homoscedasticity result using a standardized scatterplot between number of sessions and the WAI ................................................................ 162

1

Chapter I Introduction

2 Statement of the Problem In 1995, the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) completed a survey elucidating the personal characteristics of substance abuse counselors. The survey found that 75% of entry-level counselors and 58% of senior counselors were in recovery from alcohol and/or drugs. Other studies surveying the personal characteristics of substance abuse counselors found that between 30 and 70% of them identified themselves as being in recovery from alcohol and drugs (Toriello & Benshoff, 2003; White, 2000; Stoffelmayr, Mavis, Sherry, & Chiu, 1999; Stoffelmayr, Mavis, & Kasim, 1998; Mulligan, McCarty, Potter, & Krakow, 1989; McGovern & Armstrong, 1987; Blum & Roman, 1985). Lastly, Siebert (2003) completed a survey of 751 National Association of Social Workers (NASW) members and found that 28% of them identified themselves as being in recovery from alcohol and/or drugs. With such a large percentage of counselors in recovery, it is imperative to gain a better understanding of their counseling effectiveness with their clients. One way the researchers have attempted to better understand the effectiveness of recovering counselors is to compare them to non-recovering counselors. Culbreth (2000) completed a review and found 16 articles in the substance abuse treatment literature that addressed differences regarding recovering and non-recovering counselors. The author stated that research comparing the effectiveness of recovering and non-recovering counselors has focused on client perceptions (e.g., perceived expertness, trustworthiness, attractiveness, and ability to empathize) of counselor effectiveness and client treatment outcome variables. The research has found a few results favoring recovering counselors over non- recovering counselors on the process variables, but little in the way of differences on

3 client outcome variables. However, the extant research exploring the effectiveness of recovering and non-recovering counselors has failed to control for variables shown to affect the process and outcome of treatment. These variables include years of counselor education, years of counseling experience, and use of counselor disclosure. Purpose of the Study The purpose of this investigation is to determine whether a recovering counselor who is educated, experienced, and discloses his or her recovery status with their clients is more effective than an equally educated and experienced non-recovering counselor in helping their clients. A majority of the research comparing recovering and non- recovering counselors on process and client outcome variables was completed in the 1970s, 1980s, and early 1990s. A majority of the recovering counselors working in AOD treatment facilities at that time had little formal education and counseling experience, especially when compared to non-recovering counselors. According to White (1998), policies in the AOD counseling field are moving away from the traditional paraprofessional who has little formal education and counseling experience, to a more professional recovering counselor with more formal education and counseling experience. In light of these new policies that are professionalizing the role of AOD counselors, recovering counselors with more educational and counseling experience are increasingly common in the AOD treatment field. Therefore, it is important to understand how effective these more educated and clinically experienced recovering counselors can be with their clients.

4 Significance of the Study Gaining a better understanding of how effective these more educated and clinically experienced recovering counselors is important to the field of substance abuse treatment and the profession of social work. As for the field of substance abuse treatment, the literature highlights that a large percentage of counselors working in AOD facilities are themselves in recovery from a substance use disorder. For that reason, it is important for agency directors, clinical directors, and counselors who work directly with clients struggling with a substance use disorder to identify effective counselor characteristics that will support a healthy and strong counselor-client working alliance. With regard to the profession of social work, it has been apparent that social workers have been involved in helping those struggling with substance use disorders from the profession’s beginning. For instance, social workers were involved in developing self-help programs such as Alcoholics Anonymous, designing inpatient detoxification programs, and applying educational and prevention programs (NASW, 2008). Today, social workers help those struggling with substance use disorders by conducting research, advocating for improved client services, participating in planning and policy development, and serving in public office. Social workers also offer counseling to help people overcome their substance use disorder. These social workers, often called substance abuse social workers, work in AOD treatment programs and offer services that include individual and group counseling, outreach, and crisis intervention. According to the U.S. Department of Labor (2007), jobs for substance abuse social workers will increase by 30 percent over the next decade. This percentage increase is higher then for any other social work occupation. Therefore, it is important to the

5 profession of social work to identify counselor characteristics that help promote a healthy and strong counselor-client working alliance. Interpersonal Influence Theory

Much of the substance abuse treatment research on recovering counselors is dated and there are profound gaps. To organize what little is known and to identify these gaps, Strong’s Interpersonal Influence Theory (IIT) was used. According to IIT, changing or influencing a client’s attitude, perception, or behavior requires a counselor to employ certain characteristics (Strong, 1986). Strong (1968) presented a two-phase model to interpersonal influence in counseling. In phase one, the counselor must build credibility by demonstrating that he or she is an expert and is trustworthy. Counselor expertise is partially based on his or her educational degrees and credentials, such as diplomas and certificates (Miller, Kelly, Tobacyk, Thomas, & Cowger, 2001). Trustworthiness is partially based on the ability of the counselor to communicate his or her genuine concern for a client’s welfare and the ability to pay close attention to the client’s feelings and emotions. For many counselors, communicating genuine concern and paying close attention to a client’s feelings and emotions are empathic skills that generally come with years of counseling experience. In addition to credibility, a counselor must enhance his or her attractiveness to the client (Strong, 1986). Counselor attractiveness is based heavily on his or her ability to disclose feelings, experiences, or issues similar to a client’s. For example, a similar issue could involve a recovering counselor disclosing his or her recovery status in session to a client receiving treatment for a substance use disorder. As a counselor builds credibility and attractiveness, his or her social influence over the client increases. In the second phase of Strong’s model, the counselor utilizes

6 his or her social influence to change the client’s attitude, perception, and behavior. Using IIT as a framework, Figure 1 depicts a model of the impact of counselor education, counselor experience, counselor recovery status, and counselor disclosure elucidated in this review of the literature. On the left side of the model one can see how the variables of counselor education, counselor experience, counselor recovery status, and counselor disclosure are related to Strong’s concepts of expertness, trustworthiness, and attractiveness. According to Strong’s model, a counselor who is educated will be perceived by the client as an expert, a counselor with counseling experience will be perceived by the client as trustworthy, and a counselor who is in recovery from a substance use disorder and discloses this to his or her client will be perceived by the client as attractive. Once the expertness, trustworthiness, and attractiveness of the counselor are established via the independent or cumulative affect of these variables (phase one), his or her social influence over the client should increase. The counselor’s increased social influence is then used to change client attitude, perception and behavior (phase 2). On the right side of the model one can see how the cumulative affect of Strong’s expertness, trustworthiness, and attractiveness variables impact the counselor- client working alliance. The counselor-client working alliance is important because there is research showing the benefits of a strong working alliance on client outcomes in the general counseling literature (Horvath & Luborsky, 1993; Horvath & Symonds, 1991) and substance abuse treatment literature (Diamond, Liddle, Wintersteen, Dennis, Godley, & Tims, 2006; Ilgen, McKellar, Moos, Finney, 2006; Tetzlaff, Kahn, Godley, Godley, Diamond, & Funk, 2005; Connors, Carroll, DiClemente, Longabaugh, & Donovan, 1997).

Figure 1. A path diagram with the interpersonal influence theoretical (IIT) framework

Strong’s Interpersonal Influence Theory (ITT)

Expertness

Trustworthiness

Attractiveness

Disclosure

Working Alliance

Goal Client and counselor agree on goals

Bond Client perceives the counselor to be genuinely concerned

Task Client is clear about counselor tasks

Counselor Education

Recovery Status

Counseling Experience

Client Outcomes

PHASE 1 PHASE 2 - Social Influence Increases 7

8 Impact of Recovery Status on Client Perceptions of Counselor

Past research has compared differences in client perceptions of counselor effectiveness between recovering and non-recovering counselors (Culbreth, 2000). A majority of the research comparing client perceptions of counselor effectiveness utilized analogue designs. Analogue design research entails having participants view stimuli representing the counseling process in a non-interactional manner and then rating the experience. Specifically, participants read a written description, listened to an audiotape, or viewed a videotape of a counselor-client interaction and answered questions that measured their perceptions of counselor expertness, trustworthiness, attractiveness, empathy, confidence in the counselor, and preference for and opinion of a recovering or non-recovering counselor. Overall, these investigations found client perceptions favoring recovering counselors over non-recovering counselors on several treatment variables. For instance, Lawson (1982) studied a clinical sample of alcoholic patients to measure client perceptions of their counselor and the counseling process. Twenty-eight alcoholic patients receiving inpatient or outpatient treatment were randomly selected from 10 recovering alcoholic counselors and 18 non-recovering counselor’s caseloads and then asked to complete the Barrett-Lennard Relationship Inventory (BLRI). The BLRI was used to measure client responses to the counseling process, in addition to their perceptions of counselor level of regard, empathy, unconditionality, and congruence. Results found that patients of recovering counselors scored significantly higher on the BLRI than did patients of non-recovering counselors. More specifically, the unconditionality and level of regard subscales were significantly higher for patients who had recovering counselor. The author stated the results of the study suggest recovery

9 status was an important component in the quality of the relationship between the recovering counselor and the patients participating in this study. In one of the earliest analogue studies, Creegan (1984) utilized a videotaped counselor-client interaction to examine client perceptions of counselor expertness and attractiveness. Seventy-six patients receiving treatment in a residential alcoholic facility were asked to read one of two biographical descriptions of a counselor. Some of the patients read a biographical description that said the counselor was a recovering alcoholic and some patients read a description that did not mention counselor recovery status. Patients then watched one of two videotaped counseling sessions and completed the expertness and attractiveness subscales of the Counselor Rating Form (CRF). The CRF is used to measure a client’s perception of counselor on the dimensions of expertness, attractiveness and trustworthiness and is based on the principles of Strong’s Interpersonal Influence Theory and the model of counseling as an interpersonal influence process (Barak and LaCrosse, 1975). Results did not show any significant differences between the two groups of participants on the two CRF subscales. Recovery status of the counselor did not seem to affect client perceptions of counselor expertness or attractiveness. In a qualitative study completed the same year, LoSciuto, Aiken, and Ausetts (1984) completed client interviews to examine their views of their counselor. Three hundred and two clients currently receiving counseling for drug-related issues were randomly chosen from the caseloads of degreed professional counselors, non-recovering paraprofessional counselors, and recovering paraprofessional counselors. Each client was then interviewed and asked questions about counselor knowledge of illicit drugs and

10 “the street”, counselor competence in helping the client, and the quality of the counselor- client relationship. Results found that clients perceived recovering paraprofessional counselors as more knowledgeable about drug issues and the street scene. Moreover, clients were more inclined to talk about personal problems with a recovering counselor and expected and wanted more participation and support from a recovering counselor when it came to their personal and counseling-related problems. In another analogue study, Kirk, Best, and Irwin (1986) set out to test client perceptions of empathy in alcoholism counselors. Forty-two detoxified residents of an alcoholism rehabilitation center were randomly assigned to watch one of two 15-minute videotaped counselor-client role-play sessions. The videotaped counselor-client interactions were identical except for the recovery status of the counselor. That is, clients in one group were told that the psychotherapist in the videotape was a recovering alcoholic and clients in the second group were not told anything about the therapist’s recovery status. After viewing one of two videotapes each client completed an inventory to measure therapist empathy. Results found no statistically significant differences between the two groups on the perception of therapist empathy. In another analogue study completed the following year, English (1987) investigated the effects of counselor recovery status on alcoholic and non-alcoholic client perceptions of counselor expertness, attractiveness, and trustworthiness. Thirty-four males receiving inpatient treatment for alcohol dependency and 31 males who currently or recently received counseling for personal problems were randomly assigned to read one of three descriptions of a counselor. In the three descriptions the counselor had a history of counseling for an alcoholic problem, no history of a personal or alcohol

11 problem, or history of counseling for a personal problem. After reading the description, all participants watched the same videotape of a simulated counselor-client session and then completed the Counselor Rating Form-Short version (CRF-S). Results found that clients in treatment for alcohol dependency perceived recovering addictions counselors as more expert, attractive, and trustworthy compared to those clients who have experience receiving counseling for personal problems. Three years later, Ferris (1990) utilized a 2x2 factorial design to examine the perceptions of male inpatients being treated for a substance use disorder. One hundred inpatients currently in treatment were randomly assigned to one of four groups. Half the participants were told that the counselor had a master’s degree and the other half were told that the counselor was a recovering alcoholic. The participants were then asked to listen to one of two 15-minute audiotapes of a simulated counselor-client interaction. In the audiotapes, participants experienced either counselor disclosure of recovery from alcoholism or expert persuasion by the counselor based on professional experience. After listening to the audiotape, the participants completed the CRF-S. Results showed that participants in all groups perceived the counselors as equally expert, attractive, and trustworthy. In addition, the participants in all groups were equally willing to see the “same” counselor at another point in time. Utilizing an analogue design, Johnson and Prentice (1990) focused on the effects of counselor drinking status and gender on clients’ perception of counselor trustworthiness, expertness, and attractiveness, and confidence in their counselor. The investigators utilized written descriptions of a counselor-client interaction to study the perceptions of 93 mandated clients at a mental health outpatient alcohol treatment

12 facility. Specifically, clients were assigned to read either a recovering counselor-client interaction or nonrecovering counselor-client interaction and then asked to complete the CRF-S and 15 Personal Problem Inventory (15-PPI). The 15-PPI is used to measure client confidence in the counselor. Results found no significant differences on any of the variables. More importantly, recovering alcoholic counselors were not perceived as more trustworthy, expert, attractive, or more confident than non-recovering counselors. In addition, counselor recovery status was not a significant variable perceived by client’s initial perception of the counselor. In a survey study completed the same year, Savage and Stickles (1990) examined participant expectations of recovering and non-recovering alcoholism counselors. Specifically, the authors set out to test the hypothesis that participants who heard a counselor disclose a similar relevant problem would find that counselor more trustworthy and attractive. The investigators surveyed two sets of participants for this study. The first group of participants was 114 male and female graduate student/counselor and alcoholism counselors (recovering and non-recovering). The second group of participants was 184 male and female high school students (only 3 in recovery). The authors utilized the Counselor Preference Survey (CPS) to assess participants’ preference for a recovering or non-recovering alcoholism counselor and the Counselor Effectiveness Rating Scale (CERS) to measure participants’ preconceived opinion of the effectiveness of a recovering and non-recovering alcoholism counselor. Results found that a larger percentage of both the graduate student/counselor participants and high school participants preferred the recovering alcoholism counselors to the non-recovering counselors. The same two groups of participants also rated the recovering alcoholism

13 counselor significantly higher in effectiveness than the non-recovering counselors. In addition, both participant groups had a larger percentage that preferred the recovering counselor to the non-recovering counselor. In a non-analogue and correlational study, Gatlin (1995) investigated client perceptions of counselor empathy and counselor recovery status. The participants in this study consisted of 7 recovering and non-recovering alcoholic counselors and 52 patients (matched to counselors upon admission) receiving inpatient services for chemical dependency. The counselors completed several questionnaires to identify their recovery status, thinking style (e.g., concrete or abstract), and demographic information. The patients completed several self-report questionnaires, including the BLRI to measure perceived counselor empathy. Although results of the study found empathy ratings averaging about four points higher for the patients who had recovering counselors, these ratings were not found to be significant. The author concluded that there was no relationship between perceived empathy by the patients and counselor recovery status. In another analogue study, Toriello and Strohmer (2004) investigated clients’ perceptions of counselor recovery status and counselor credibility. The investigators had 116 clients currently receiving addictions counseling view one of several videotaped counselor-client interactions. The videotaped interactions varied by counselor recovery status (recovering vs. non-recovering), counselor interactional style, and counselor nonverbal behavior. After viewing the videotaped counselor-client interaction, the participants completed the CRF-S, Client Preference Form (CPF), and a demographic questionnaire. Results showed client perception of counselor credibility was similar

Full document contains 177 pages
Abstract: Although evidence shows that between 30 and 75 percent of alcohol and other drug (AOD) counselors are themselves in recovery from a substance use disorder, dated research comparing the effectiveness of recovering and non-recovering counselors failed to control for education, experience, and use of disclosure. Given that the strength of the working alliance between client and counselor is highly predictive of outcome and utilizing interpersonal influence theory as an organizing framework, a path model was hypothesized which posited (a) counselor recovery status and its disclosure impact counselor attractiveness which, in turn, impacts working alliance; (b) counselor education impacts counselor expertness which, in turn, impacts working alliance; and (c) counselor experience impacts counselor trustworthiness which, in turn, impacts working alliance. To test this model, a causal comparative/ex post facto design was used. Participants included 31 AOD counselors and 180 clients receiving inpatient and residential treatment for a substance use disorder. Counselor recovery status, disclosure, education, and experience were collected using forms designed by the investigator. Counselor attractiveness, expertness, and trustworthiness were assessed with the Counselor Rating Form-Short, while working alliance was assessed with the Working Alliance Inventory. Data were collected from seven inpatient and residential programs in Albany, New York. A path analysis was done using a series of multiple regression analyses. Recovery status and education had significant indirect effects on working alliance. Specifically, counselors in recovery were perceived as significantly more attractive to clients and those perceived as more attractive had a significantly stronger working alliance (B = 1.992, p < .05). Likewise, more educated counselors were perceived as more expert to clients and those perceived as more expert had a significantly stronger working alliance (B = 2.434, p < .01). Experience and disclosure had neither significant direct nor indirect effects on working alliance. This investigation demonstrates the impact of counselor recovery status and education on working alliance. A chief limitation is the lack of control for other client variables that also affect working alliance, including quality of current and past relationships and counselor gender. Nevertheless, a key theoretical implication is that counselor recovery and education are not sufficient to impact working alliance; a client must perceive these things. Consequently, a key practice implication is that both recovering and non-recovering counselors can promote a stronger working alliance by identifying and utilizing skills that enhance a client's perception of expertness and attractiveness. Future research must take into account counselor recovery status and education when studying the effects of counselor characteristics on treatment outcomes.