An examination of mandated versus voluntary referral as a determinant of clinical outcome

J Marital Fam Ther. 2009 Jul;35(3):278-92. doi: 10.1111/j.1752-0606.2009.00118.x.


A literature review was undertaken to examine evidence for the effectiveness of psychotherapy with mandated clients. The primary question addressed was whether or not clients mandated to therapy, whether by court order or by order of their employers, show poorer outcomes than clients who enter therapy voluntarily. To this end, research on client resistance and motivational readiness to change was reviewed. This was followed by an examination of research on the effectiveness of mandated treatment. The question of the potential influence of relationship factors such as the therapeutic alliance was also addressed. The literature review was followed by suggestions for future research on the effectiveness of treatment for clients with mandated or voluntary referral status.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Defense Mechanisms
  • Family Therapy*
  • Humans
  • Mandatory Programs*
  • Motivation
  • Outcome and Process Assessment, Health Care
  • Professional-Family Relations
  • Professional-Patient Relations
  • Prognosis
  • Psychotherapy*
  • Referral and Consultation*
  • Substance-Related Disorders / psychology
  • Substance-Related Disorders / rehabilitation
  • Voluntary Programs*