Assessing relationship quality in mandated community treatment: Blending care with control.

TLDR

In mandated treatment, providers simultaneously care for and control involuntary clients, yet existing alliance measures fail to capture this dual‑role dynamic. The authors developed and validated a revised Dual‑Role Relationships Inventory (DRI‑R) in two studies of 90 and 322 probationers mandated to psychiatric treatment. The DRI‑R reliably measures caring, fairness, trust, and an authoritative style, correlates with alliance, satisfaction, symptoms, and motivation, predicts rule compliance, and outperforms a leading alliance measure in capturing dual‑role relationship quality.

Abstract

Traditional measures of the therapeutic alliance do not capture the dual roles inherent in relationships with involuntary clients. Providers not only care for, but also have control over, involuntary clients. In 2 studies of probationers mandated to psychiatric treatment (n=90; n=322), the authors developed and validated the revised Dual-Role Relationships Inventory (DRI-R). The authors found that (a) relationship quality in mandated treatment involves caring and fairness, trust, and an authoritative (not authoritarian) style, (b) the DRI-R assesses these domains of relationship quality, is internally consistent, and relates in a theoretically coherent pattern with ratings of within-session behavior and with measures of the therapeutic alliance, relationship satisfaction, symptoms, and treatment motivation, and (c) the quality of dual-role relationships predicts future compliance with the rules, as assessed by probation violations and revocation. The DRI-R covaries with multiple domains more strongly than a leading measure of the therapeutic alliance, suggesting that it better captures the nature and effect of relationship quality in mandated treatment.