Therapist Empathy, Combined Behavioral Intervention, and Alcohol Outcomes in the COMBINE Research Project

Objective: Common factors such as therapist empathy play an important role in treatment for addictive behaviors. The present study was a secondary analysis designed to evaluate the relation between therapist empathy and alcohol treatment outcomes in data from a large, multisite, randomized controlled trial. Method: Audio-recorded psychotherapy sessions for 38 therapists and 700 clients had been randomly selected for fidelity coding from the combined behavioral intervention condition of Project COMBINE. Sessions were evaluated by objective raters for both specific content (coping with craving, building social skills, and managing negative mood) and relational components (empathy level of the therapist). Multilevel modeling with clients nested within therapists evaluated drinks per week at the end of treatment. Results: Approximately 11% of the variance in drinking was accounted for by therapists. A within-therapist effect of empathy was detected (B = −0.381, SE = 0.103, p < .001); more empathy than usual was associated with subsequent decreased drinking. The Social and Recreational Counseling module (B = −0.412, SE = 0.124, p < .001), Coping with Cravings and Urges module (B = −0.362, SE = 0.134, p < .01), and the Mood Management module (B = −0.403, SE = 0.138, p < .01) were also associated with decreased drinking. No between-therapist effect was detected, and the Empathy × Module Content interactions were not significant. Conclusions: The results of the study appear consistent with the hypothesis that skills building and therapist empathy are independent contributions to the overall benefit derived from the combined behavioral intervention. What is the public health significance of this article? This study suggests that the interpersonal skills of the therapist influence the effectiveness of a behavioral treatment for problem drinking.