Academic journal article Journal of Mental Health Counseling

Strengthening the Working Alliance for Clients with Substance Use Disorders and Child Maltreatment Histories

Academic journal article Journal of Mental Health Counseling

Strengthening the Working Alliance for Clients with Substance Use Disorders and Child Maltreatment Histories

Article excerpt


Child maltreatment includes all forms of physical, sexual, and emotional abuse, neglect, and exploitation that result in harm or possible harm to a child's health, development, or self-worth (World Health Organization & International Society for Prevention of Child Abuse and Neglect, 2006). According to the Centers for Disease Control and Prevention (2017), there were 683,000 cases of child maltreatment reported to child protective services in 2015. It is estimated that 25% of children will experience some form of abuse or neglect in childhood (Finkelhor, Turner, Shattuck, & Hamby, 2013). Several studies have demonstrated that a considerable number of individuals who experience child maltreatment ultimately develop substance use disorders (Felitti et al., 1998; Fergusson, McLeod, & Horwood, 2013; Sacks, McKendrick, & Banks, 2008). The lasting effects of maltreatment are believed to contribute to reductions in the counseling working alliance, likely resulting in premature termination or ineffective interventions (Lawson, Davis, & Brandon, 2013; Meier, Donmall, McElduff, Barrowclough, & Heller, 2006; Pearlman & Courtois, 2005; Wampold, 2001).

Exposure to sexual and physical abuse in childhood significantly contributes to mental and emotional disorders in adulthood (Fergusson, Boden, & Horwood, 2008; Fergusson et al., 2013). Severity of maltreatment is found to increase mental illnesses (depression, anxiety, posttraumatic stress disorder, and suicidality) in adulthood even when controlling for confounding socioeconomic and sociodemographic factors (Fergusson et al., 2013). A significant positive relationship also exists between child maltreatment and substance-related issues in adulthood (Dube, Anda, Felitti, Edwards, & Croft, 2002), regardless of family history of alcoholism (Dube et al., 2003). Multiple studies (Draucker & Mazurczyk, 2013; Dube et al., 2002; Fergusson et al., 2008; Fergusson et al., 2013) have demonstrated that individuals with child maltreatment histories are more likely to meet the criteria for substance dependence. Dube et al. (2002) found that the probability of early drug use initiation was 2 to 4 times greater among those who reported higher incidents of childhood adversity and maltreatment in a sample of 17,337 adults. Felitti et al. (1998) found that individuals who were exposed to more than four instances of maltreatment in childhood were 7 to 10 times more likely to be dependent on alcohol or engage in intravenous drug use.

A growing body of research has been dedicated to understanding substance abuse treatment for individuals with trauma histories in general (Torchalla, Nosen, Rostam, & Allen, 2012). However, little is understood regarding the specific impact of child maltreatment histories relative to substance abuse treatment outcomes (Sacks et al., 2008). The lasting effects of child maltreatment can span the life and can negatively affect health, learning, and social outcomes (Noll, 2008; Waldinger, Schulz, Barsky, & Ahern, 2006). Additionally, many people who survive maltreatment demonstrate a reduced capacity to cope with and regulate emotions and to build relationships with others (Shenk, Griffin, & O'Donnell, 2015; Substance Abuse and Mental Health Services Administration, 2014). The need for counseling among individuals who have both child maltreatment and substance use disorders is clear; however, the enduring effects of maltreatment are believed to have a negative impact on the counseling working alliance and treatment in general (Lawson et al., 2013, Meier et al., 2006; Pearlman & Courtois, 2005; Wampold, 2001).


The working alliance is largely considered the foundation for therapeutic change (Wampold, 2001). The working alliance involves the bond that is formed between the therapist and client, along with the goals that are set for therapy, including specific tasks to accomplish these goals (Bordin, 1979). …

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