Therapeutic alliance and multiple psychotherapy in the context of therapist rotation: Experiences with OLITA

Despite a long tradition of client-centered approaches in addiction therapy, these approaches have not been broadly applied until the 90s of the last century, since treatment programs were predominantly based on behavior therapy. However, due to dissemination of and research on motivational interviewing (MI) over the last 20 years, client-centered therapy has become increasingly accepted in routine care of patients with substance use disorders. Originally, W. R. Miller and S. Rollnick did not establish MI as a brief intervention. Nevertheless, research on MI has mainly been performed within the context of brief interventions. As a consequence, empirically supported client-centered interventions that are based on long-term treatment are largely missing in addiction therapy. OLITA, the Outpatient Long-term Intensive Therapy for Alcoholics, may be one of few exceptions. OLITA is a comprehensive long-term treatment program that is fully compatible with the principles of MI and that combines elements of client-centered and behavior therapy. This review article presents a synopsis of the published literature on OLITA, focusing on aspects of therapeutic alliance and multiple psychotherapy. After a short introduction of the therapy program, we delineate how client-centered therapy is integrated in the context of therapist rotation. The most important data on process-outcome research in OLITA are summarized. Our results suggest that the therapeutic alliance is a major treatment factor that is strongly associated with the eight treatment processes of the TOPPS (Therapy Orientation by Process Prediction Score) that, in turn, is highly predictive of long-term alcohol abstinence. Based on experience of clinical care and training of OLITA therapists, we show in the practical part of this article how to implement therapist rotation and multiple psychotherapy, as well as how to apply communication and interaction skills to build a successful working alliance.