Working alliance, therapist expressive skills, and client outcome in psychodynamic therapy.

Client Outcomes and the Working Alliance in Assertive Community Treatment Programs

Care Management Journals ◽

10.1891/cmaj.2004.5.4.199 ◽

2004 ◽

Vol 5 (4) ◽

pp. 199-202 ◽

Cited By ~ 7

Author(s):

Robert J. Calsyn ◽

Gary A. Morse ◽

W. Dean Klinkenberg ◽

Matthew R. Lemming

Keyword(s):

Substance Use ◽

Working Alliance ◽

Assertive Community Treatment ◽

Psychiatric Symptoms ◽

Case Manager ◽

Self Report ◽

Community Treatment ◽

Treatment Programs ◽

Client Outcome ◽

Abuse Treatment

This study examined the relationship between outcomes and the working alliance in clients who were receiving assertive community treatment only or integrated assertive community treatment (assertive community treatment plus substance abuse treatment). All 98 participants had a severe mental illness and a substance use disorder. The Working Alliance Inventory assessed the alliance from the perspective of both the client and the case manager at 3 and 15 months into treatment. The six outcome measures were stable housing, client rating of psychiatric distress, interviewer rating of psychiatric symptoms, self-report of days used alcohol or drugs, and interviewer rating of substance use. Only 4 of 24 correlations were significant, indicating little relationship between the strength of the working alliance and client outcome.

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Client Outcomes and the Working Alliance in the Client–Case Manager Relationship: A Causal Analysis

Care Management Journals ◽

10.1891/152109807781753745 ◽

2007 ◽

Vol 8 (3) ◽

pp. 106-112 ◽

Cited By ~ 3

Author(s):

Jennifer Cunningham ◽

Robert J. Calsyn ◽

Gary K. Burger ◽

Gary A. Morse ◽

W. Dean Klinkenberg

Keyword(s):

Causal Relationship ◽

Working Alliance ◽

Structural Equation ◽

Rating Scale ◽

Psychiatric Symptoms ◽

Case Manager ◽

Community Treatment ◽

Equation Modeling ◽

Client Outcomes ◽

Client Outcome

This study investigated the causal relationship between the working alliance and client outcomes in the client–case manager relationship. All 162 study participants received services from a case manager who worked as a member of an assertive community treatment team. All participants had both a substance use disorder and a diagnosis of severe mental illness and were homeless at baseline. A brief form of the Working Alliance Inventory (WAI) was used to measure the working alliance after 3 and 15 months of treatment. The Brief Psychiatric Rating Scale was used to measure psychiatric symptoms at baseline, 9, and 18 months. Days per month that clients used alcohol or illegal drugs was also assessed at baseline, 9, and 18 months. The data were analyzed using structural equation modeling (SEM). The correlations between the working alliance and the outcome measures were lower than similar correlations obtained in studies investigating the psychotherapy relationship. The SEM analyses revealed little or no causal relationship between the working alliance and client outcome in this sample.

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