The relationship of therapeutic alliance to outcome in wilderness treatment

The author examined therapeutic alliance in relation to a standardized measure of social and psychological outcomes for adolescents with behavioural, emotional and substance use diagnoses in a wilderness treatment programme. Client self-ratings of treatment outcome and therapeutic alliance were found to improve significantly. However, early alliance scores and change from early- to post-treatment alliance scores were not predictive of treatment outcomes as suggested in treatment literature. Questions concerning wilderness leader/therapist roles, wilderness effect and involuntary treatment related to alliance are raised. Methodological difficulties in completing this line of research are shared and implications for practice are discussed.