Community Mental Health Journal

, Volume 49, Issue 4, pp 438–443 | Cite as

Longitudinal Association of Therapeutic Alliance and Clinical Outcomes in Supported Housing for Chronically Homeless Adults

  • Jack Tsai
  • Adrienne Lapidos
  • Robert A. Rosenheck
  • Ilan Harpaz-Rotem
Brief Report


General psychotherapy research has underscored the importance of the therapeutic alliance in client outcomes. This study examined the association between therapeutic alliance and client outcomes specifically between chronically homeless clients in a supported housing program and their case managers. Using data from a federal supported housing initiative, participants were categorized into those who rated their therapeutic alliance with case managers at 3 months as relatively high (top 75th percentile; n = 123), relatively low (bottom 25th percentile; n = 128), or did not identify any primary mental health provider at 3 months (n = 205). Controlling for baseline differences, there were no group differences on any outcomes, except that participants who rated high therapeutic alliance at 3 months reported the highest subjective quality of life and perceived social support. Client outcomes in supported housing may rely more on practical assistance and access to other services than the quality of the therapeutic relationship with their primary mental health provider.


Therapeutic alliance Homeless persons Supported housing Case management 



The CICH Funder’s Group representing U.S. Department of Housing and Urban Development, Health and Human Services, and Veterans Affairs provided essential support and guidance to this evaluation. The CICH evaluation has been completed and the Federal Government is no longer involved. This material was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development.

Conflict of interest

None of the authors had any conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC (Outside the USA) 2012

Authors and Affiliations

  • Jack Tsai
    • 1
    • 2
    • 3
    • 4
  • Adrienne Lapidos
    • 2
    • 4
  • Robert A. Rosenheck
    • 1
    • 2
    • 3
    • 4
  • Ilan Harpaz-Rotem
    • 1
    • 2
    • 3
    • 4
  1. 1.VA New England Mental Illness Research, Education, and Clinical CenterWest HavenUSA
  2. 2.VA Connecticut Healthcare SystemWest HavenUSA
  3. 3.Department of PsychiatryYale School of MedicineNew HavenUSA
  4. 4.Yale School of Public HealthNew HavenUSA

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