Society for Social Work and Research

The significance of client-provider relationship as an ingredient in the delivery of social services has been a persistent question in social work research. Examining the role of client-provider relationship is important given (1) its historic significance in social work practice, as well as (2) emerging research documenting the capacity of client-provider relationship to function as a determinant of change across health and social service delivery systems. Much of the research on client-provider relationship or therapeutic alliance has been located in the psychotherapy literature where many of the outcome studies have focused more on validating the efficacy of treatments or technical interventions than on understanding client-provider relationship as an active ingredient of change. Further, quantitative reviews and meta-analyses in the psychotherapy literature are increasingly showing specific techniques account for between 5% and 15% of outcome variance, while factors related to client-provider relationship can account for more. This research has contributed to a growing interest in expanding client-provider relationship research beyond the psychotherapy literature to service systems where social workers are actively engaged: mental health, child welfare and substance abuse.

The purpose of this symposium is to examine client-provider relationship as an active ingredient in the delivery of social services and to assess what we have learned over the last fifteen years about its relationship to treatment and service outcomes in mental health (services for the severely and chronically mentally ill), child welfare and substance abuse. In the process, we will define core constructs and variables, describe associations and possible causal relationship among variables, identify possible mediating mechanisms, and ultimately highlight the gaps in knowledge that point to promising directions for future research and practice.

This symposium will bring together three different analytic strategies for studying client-provider relationship across three social service systems: (1) A systematic review of the literature on the impact of client-provider relationship on outcome in mental health, child welfare and substance abuse; (2) a qualitative analysis of the role of relationship in the process of recovery in mental illness; (3) a quantitative analysis of proportion of variance accounted for by client-provider relationship in substance abuse treatment; and (4) a quantitative analysis of the relation of client-provider relationship to outcome with adults with serious mental illness using well-validated measures of alliance. All approaches focus on the measurement and analysis of client-provider relationship in relation to outcome across the mental health, child welfare or substance abuse service systems. The papers in the symposium will address the following three questions:

(1) What are conceptualization and measurement considerations in research on client-provider relationship? (2) To what extent do analyses inform understanding of the relation of client-provider relationship to outcome across systems as well as mediating factors that strengthen or limit its impact? (3) What are implications of the findings for enhancing research and practice on the impact of client-provider relationship in the provision of mental health, child welfare and substance abuse treatment services.