Patients’ perspective on an optimal therapeutic alliance; facilitating engagement in treatment of antisocial personality disorder

OBJECTIVE: While the knowledge about developing an effective therapeutic alliance (TA) with patients diagnosed with an antisocial personality disorder (ASPD) is growing, little is known from patients' perspective. Given the important role of TA in therapy outcomes, a deeper understanding of the factors contributing to a strong TA is essential. This study aims to expand current knowledge by exploring the experiences and preferences of patients with ASPD regarding TA development. METHOD: A qualitative research design was employed using reflective thematic analysis. Fifteen in-depth interviews were conducted with patients diagnosed with ASPD and analyzed for recurring themes. RESULTS: Seven themes were identified and grouped into two categories. The first category, "Facilitators" reflects therapeutic attitudes that align with the needs of patients with ASPD. The second category, "Barriers to engage" describes the difficulties patients experience in forming a TA. CONCLUSIONS: Although patients with ASPD often experience establishing a TA as challenging, TA development can be achieved when therapists adapt their approach to patients' needs. Patients want a genuine, authentic therapist who can provide a pleasant, collaborative atmosphere. By maintaining a non-judgmental and calm attitude, while adopting a firm and clear style, therapists support patients' engagement and promote TA development.