Bridging Disciplinary Boundaries (January 11 - 14, 2007)

In this symposium, we propose that research on the case management relationship may be enriched by honing in on the nature and contribution of the case manager perspective. That is, most previous studies focus almost exclusively on the contribution of client-level characteristics, such as psychiatric symptoms and client demographics, in predicting the client-provider relationship. Such a focus may potentially lead to an overemphasis on client pathology and consequent underattention to characteristics and behaviors of providers that may also differentiate high and low quality case management relationships.

The symposium brings together findings from three studies of the case management relationship that employ innovative approaches to the study of the provider contribution. The first paper takes as point of departure a finding of low congruence between client and provider-reported alliance (consistent with several previous studies) and uses a qualitative approach to explore areas of convergence and divergence between client and case manager perspectives. As the findings highlight, case managers and clients possess unique perspectives on the relationship which should be taken into account in both research and practice. The second paper follows upon this theme by presenting a grounded theory study of the ways that case managers conceptualize the client-provider relationship in assertive community treatment. The study finds that the key dimensions discussed by case managers are not well assessed by existing instruments, and thus, the paper details the use of this conceptualization in the development of a new instrument to measure the relationship from the case manager perspective. The third paper examines the contribution of the case manager's clinical reasoning processes to the relationship as perceived by clients. Findings show that when case managers think about the problem of medication nonadherence in a differentiated manner (as opposed to a more simplistic reasoning style), their clients report both a stronger positive relationship valence (e.g., more liking and trust) and a less negative relationship valence (e.g., less conflict and resentment).

As a set, the papers exemplify novel conceptual and methodological approaches to the study of the case management relationship. Taken together, the studies identify that the provider's contribution to the relationship is distinct from that of the client, and therefore warrants further study. These findings also carry important implications for the training of case management practitioners.