Methods: 60 dyads of case managers and consumers were recruited from 20 ICM sites in the Philadelphia area. Inclusion criteria included a diagnosis of schizophrenia or schizoaffective disorder, at least 18 years of age, and having been newly referred to ICM services. Case managers and consumers were each interviewed at five time points across a nine month period. Outcomes were measured using the Working Alliance Inventory (WAI), the Helping Alliance Questionnaire –II (HAq-II), the Brief Psychiatric Rating Scale, the Lehman Quality of Life Inventory, and case manager ratings of client service participation. OLS regression models were run using independent variables measured at baseline and three months, and dependent variables measured at nine months.
Results: When controlling for baseline symptomatology, age of first hospitalization, lifetime number of hospitalizations, and lagged measures of the dependent variables, alliance measured at three months was predictive of consumer service participation and social behaviors measured at nine months. Specifically, alliance from the case manager perspective, as measured by both the WAI and HAq-II, significantly predicted case managers' rating of consumer participation in services since entering treatment. Similarly, the case manager perspective of the alliance, captured by the WAI, was predictive of consumers' reports of their own social contact behaviors. When measured by the HAq-II, the case manager alliance was also predictive of social contact at a trend level, as was the consumer rating of alliance using the WAI.
Conclusions and Implications: A recent systematic review (Priebe et al., 2011) characterized the role of the therapeutic relationship in outcome in psychiatric services as present, but not overwhelming. Analyses reported in this presentation, which improve upon the shortcomings of many past studies, accord with this assessment. Generally, the alliance measures predicted consumers' success in social functioning and participation in services, with the case manager's assessment having the most potent association to these outcomes. This suggests that what may be assessed by existing alliance measures is the consumer's sociability and motivation to engage in services, but not necessarily his or her ability to make improvements in other outcome areas. Because consumer surveys suggest the importance of the therapeutic relationship to consumer recovery, further study of this association, using measures tailored to the context of psychiatric rehabilitation, is warranted.
