Strengthening the working alliance through a clinician’s familiarity with the 12-step approach


Therapeutic relationship, working alliance, 12-step programs, substance use disorder treatment


Background: The working alliance plays an important role in the substance use disorder treatment process. Many substance use disorder treatment providers incorporate the 12-Step approach to recovery into treatment. With the 12-Step approach known among many clients and clinicians, it may well factor into the therapeutic relationship. Objective: We investigated how, from the perspective of clients, a clinician’s level of familiarity with and in-session time spent on the 12-Step approach might affect the working alliance between clients and clinicians, including possible differences based on a clinician’s recovery status. Method: We conducted a secondary study using data from 180 clients and 31 clinicians. Approximately 81% of client participants were male, and approximately 65% of clinician participants were female. We analyzed data with Stata using a population-averaged model. Results: From the perspective of clients with a substance use disorder, clinicians’ familiarity with the 12-Step approach has a positive relationship with the working alliance. The client-estimated amount of in-session time spent on the 12-Step approach did not have a statistically significant effect on ratings of the working alliance. A clinician’s recovery status did not moderate the relationship between 12-Step familiarity and the working alliance. Conclusion: These results suggest that clinicians can influence, in part, how their clients perceive the working alliance by being familiar with the 12-Step approach. This might be particularly salient for clinicians who provide substance use disorder treatment at agencies that incorporate, on some level, the 12-Step approach to recovery.

Original Publication Citation

Dennis, C. B., Roland, B. D., & Loneck B. M. (2018). Strengthening the working alliance through a clinician’s familiarity with the 12-Step approach. The American Journal of Drug and Alcohol Abuse, 44(3), 378-385.

Document Type

Peer-Reviewed Article

Publication Date



The Journal of Drug and Alcohol Abuse




Family, Home, and Social Sciences


Social Work

University Standing at Time of Publication

Assistant Professor