The Impact of Adverse Childhood Events on Therapy Alliance in Male Inpatients with Convictions

ABSTRACT

Although there is an increasing focus on therapy alliance and its predictive factors, there has been limited exploration of these predictive factors within forensic services. Adverse childhood experiences (ACEs) could be one of these possible factors. In the present study, we examined whether ACEs are predictive for therapy alliance in male inpatients with cluster B personality disorders who are convicted for a violent offense. We were specifically interested in the predictive value of ACEs on therapy alliance at 18 months into treatment, and whether personality pathology mediates this relationship. ACEs, self-rated and observer-rated therapy alliance, and personality pathology were assessed within 103 male offenders and analyzed using hierarchical multiple regression analyses, and mediation analyses using PROCESS. Results show that self-rated agreement on therapy tasks was predicted by emotional neglect, whereas observer-rated agreement on therapy tasks was predicted by physical neglect. Physical, sexual, and emotional abuse were not predictive for therapy alliance. Personality disorders were no mediating factors. Despite limitations, this study emphasizes the importance of childhood neglect in treatment of male inpatients with convictions for violent offenses and contributes to our understanding of the concept of therapy alliance in people with convictions.

KEYWORDS:

• Adverse childhood experiences
• therapy alliance
• offenders
• personality disorders
• mediation

Acknowledgments

The authors take responsibility for the integrity of the data, the accuracy of the data analyses, and have made every effort to avoid inflating statistically significant results. We kindly thank all patients and therapists for their time and effort spent on this study and the director of all participating forensic hospitals for their support and resources. Finally, we thank Maartje Clercx for providing feedback on our manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ Baseline measures included a very high number of measures and were split over two collection sessions to reduce the burden on participating patients. Furthermore, some variables are more informative after having actually received some treatment, such as therapy alliance.