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"Establishing and Maintaining a Therapeutic Alliance with
Substance Abuse Patients: A Cognitive Therapy Approach."

I. COMMON OBSTACLES TO FORMING A THERAPEUTIC ALLIANCE

II. ESTABLISHING RAPPORT AT THE OUTSET OF TREATMENT

Speak directly, simply, and honestly.
Ask about the patient's thoughts and feelings about being in therapy.
Focus on the patient's distress.
Acknowledge the patient's ambivalence.
Explore the purpose and goals of treatment.
Discuss the issue of confidentiality.
Avoid judgmental comments.
Appeal to the patient's areas of positive self-esteem.
Acknowledge that therapy is difficult.
Ask open-ended questions, then be a good listener.

III. MAINTAINING A POSITIVE ALLIANCE OVER THE COURSE OF TREATMENT

Ask patients for feedback about every session.
Be attentive. Remember details about the patients from session to session.
Use imagery and metaphors that the patients will find personally relevant.
Be consistent, dependable, and available.
Be trustworthy, even when the patient is not.
Remain calm and cool in session, even if the patient is not.
Be confident, but be humble.
Set limits in a respectful manner.

IV. THE THERAPEUTIC RELATIONSHIP AND THE CASE FORMULATION

Strive to understand the pain and fear behind the patient's hostility and resistance.
Explore the meaning and function of the patient's seemingly oppositional or self defeating actions.
Assess the patient's beliefs about therapy.
Assess your own beliefs about the patient.
Collaboratively utilize unpleasant feelings in the therapeutic relationship as grist for the mill.

V. CONCLUSION

.... REFERENCES

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