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

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Abstract

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.

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References

  • Anthony, W. A. (2008). A recovery oriented service system. In G. Gamst, A. Der-Karabetian, & R. H. Dana (Eds.), Readings in multicultural practice. Thousand Oaks: Sage Publications.

    Google Scholar 

  • Catty, J., White, S., Koletsi, M., Becker, T., Fioritti, A., Kalkan, R.,…EQOLISE Group. (2011). Therapeutic relationships in vocational rehabilitation: Predicting good relationships for people with psychosis. Psychiatry Research, 187(1–2), 68–73.

    Google Scholar 

  • Chinman, M. J., Rosenheck, R. A., & Lam, J. A. (1999). The development of a relationships between people who are homeless and have a mental disability and their case managers. Psychiatric Rehabilitation Journal, 23(1), 47–55.

    Article  Google Scholar 

  • Chinman, M. J., Rosenheck, R. A., & Lam, J. A. (2000). The case management relationship and outcomes of homeless persons with serious mental illness. Psychiatric Services, 51(9), 1142–1147.

    Article  PubMed  CAS  Google Scholar 

  • Couture, S. M., Roberts, D. L., Penn, D. L., Cather, C., Otto, M. W., & Goff, D. (2006). Do baseline client characteristics predict the therapeutic alliance in the treatment of schizophrenia. Journal of Nervous and Mental Disease, 194(1), 10–14.

    Article  PubMed  Google Scholar 

  • Davis, L. W., & Lysaker, P. H. (2007). Therapeutic alliance and improvements in work performance over time in patients with schizophrenia. Journal of Nervous and Mental Disease, 195(4), 353–357.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R., & Spencer, N. (1982). The brief symptom inventory: Administration, scoring, and procedure manual. Baltimore: Johns Hopkins.

    Google Scholar 

  • Desai, M. M., & Rosenheck, R. A. (2005). Unmet need for medical care among homeless adults with serious mental illness. General Hospital Psychiatry, 27(6), 418–425.

    Article  PubMed  Google Scholar 

  • Gehrs, M., & Goering, P. (1994). The relationship between the working alliance and rehabilitation outcomes of schizophrenia. Psychosocial Rehabilitation Journal, 18(2), 43–54.

    Article  Google Scholar 

  • Horvath, A. O., & Greenberg, L. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.

    Article  Google Scholar 

  • Howgego, I. M., Yellowlees, P., Owen, C., Meldrum, L., & Dark, F. (2003). The therapeutic alliance: The key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Australian and New Zealand Journal of Psychiatry, 37(2), 169–183.

    Article  PubMed  Google Scholar 

  • Johansson, H., & Eklund, M. (2006). Helping alliance and early dropout from psychiatric out-patient care: The influence of patient factors. Social Psychiatry and Psychiatric Epidemiology, 41(2), 140–147.

    Article  PubMed  Google Scholar 

  • Klinkenberg, W. D., Calsyn, R. J., & Morse, G. A. (1998). The helping alliance in case management for homeless persons with severe mental illness. Community Mental Health Journal, 34(6), 569–578.

    Article  PubMed  CAS  Google Scholar 

  • Kukla, M., & Bond, G. R. (2009). The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs. Rehabilitation Psychology, 54(2), 157–163.

    Article  PubMed  Google Scholar 

  • Larson, C. O. (2002). Use of the SF-12 instrument for measuring the health of homeless persons. Health Services Research, 37, 733–750.

    Article  PubMed  Google Scholar 

  • Lehman, A. F. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11(1), 51–62.

    Article  Google Scholar 

  • Luborsky, L., Rosenthal, R., Diguer, L., Andrusyna, T. P., Berman, J. S., Levitt, J. T.,…Krause, E. D. (2002). The dodo bird verdict is alive and well-mostly. Clinical Psychology: Science and Practice, 9, 2–12.

    Google Scholar 

  • Lustig, D. C., Strauser, D. R., Rice, D. W., & Rucker, T. F. (2002). The relationship between working alliance and rehabilitation outcomes. Rehabilitation Counseling Bulletin, 46(1), 24–32.

    Article  Google Scholar 

  • Lysaker, P. H., Glynn, S. M., Wilkniss, S. M., & Silverstein, S. M. (2010). Psychotheray and recovery from schizophrenia: a review of potential applications and need for future study. Psychological Services, 7(2), 75–91.

    Article  PubMed  Google Scholar 

  • Mares, A. S., & Rosenheck, R. A. (2009). HUD/HHS/VA collaborative initiative to help end chronic homelessness. West Haven: Northeast Program Evaluation Center.

    Google Scholar 

  • Mares, A. S., & Rosenheck, R. A. (2010). Twelve-month client outcomes and service use in a multisite project for chronically homelessness adults. Journal of Behavioral Health Services & Research, 37, 167–183.

    Article  Google Scholar 

  • Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.

    Article  PubMed  CAS  Google Scholar 

  • McCabe, R., Roder-Wanner, U. U., Hoffmann, K., & Priebe, S. (1999). Therapeutic relationships and quality of life: Association of two subjective constructs in schizophrenia patients. International Journal of Social Psychiatry, 45(4), 276–283.

    Article  PubMed  CAS  Google Scholar 

  • McLellan, A. T., Luborsky, L., Woody, G. E., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26–33.

    Article  PubMed  CAS  Google Scholar 

  • Neale, M. S., & Rosenheck, R. A. (1995). Therapeutic alliance and outcome in a VA intensive case management program. Psychiatric Services, 46, 719–723.

    PubMed  CAS  Google Scholar 

  • Priebe, S., Richardson, M., Cooney, M., Adedeji, O., & McCabe, R. (2011). Does the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review. Psychotheray and Psychosomatics, 80(2), 70–77.

    Article  Google Scholar 

  • Rosenheck, R. A., & Lam, J. A. (1997). Client and site characteristics as barriers to service use by homeless persons with serious mental illness. Psychiatric Services, 48(3), 387–390.

    PubMed  CAS  Google Scholar 

  • Rosenstock, I. M. (2005). Why people use health services. Milbank Quarterly, 83(4), 1–32.

    Article  Google Scholar 

  • Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy: “at last the Dodo said, ‘everybody has won and all must have prizes’”. American Journal of Orthopsychiatry, 6, 412–415.

    Article  Google Scholar 

  • Shelley, D., Cantrell, J., Warn, D., & Wong, S. (2010). Smoking cessation among sheltered homeless: A pilot. American Journal of Health Behavior, 34(5), 544–552.

    Article  PubMed  Google Scholar 

  • Solomon, P., Draine, J., & Delaney, M. A. (1995). The working alliance and consumer case management. Journal of Mental Health Administration, 22(2), 126–134.

    Article  PubMed  CAS  Google Scholar 

  • Tryon, G. S., Blackwell, S. C., & Hammel, E. F. (2007). A meta-analytic examination of client-therapist perspectives of the working alliance. Psychotherapy Research, 17(6), 629–642.

    Article  Google Scholar 

  • Vermeire, E., Hearnshaw, H., Van Royen, P., & Denekens, J. (2001). Patient adherence to treatment: Three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics, 26(5), 331–342.

    Article  PubMed  CAS  Google Scholar 

  • Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

    Article  PubMed  Google Scholar 

  • Weiss, M., Gaston, L., Propst, A., Wisebord, S., & Zicherman, V. (1997). The role of the alliance in the pharmacologic treatment of depression. Journal of Clinical Psychiatry, 58(51), 196–204.

    Article  PubMed  CAS  Google Scholar 

  • Wittorf, A., Jakobi, U., Bechdolf, A., Muller, B., Sartory, G., Wagner, M.,…Klingberg, S. (2009). The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia. European Psychiatry, 24(4), 259–267.

    Google Scholar 

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Acknowledgments

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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Authors and Affiliations

  1. VA New England Mental Illness Research, Education, and Clinical Center, West Haven, 950 Campbell Ave., 151D, West Haven, CT, 06511, USA

    Jack Tsai, Robert A. Rosenheck & Ilan Harpaz-Rotem

  2. VA Connecticut Healthcare System, West Haven, CT, USA

    Jack Tsai, Adrienne Lapidos, Robert A. Rosenheck & Ilan Harpaz-Rotem

  3. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Jack Tsai, Robert A. Rosenheck & Ilan Harpaz-Rotem

  4. Yale School of Public Health, New Haven, CT, USA

    Jack Tsai, Adrienne Lapidos, Robert A. Rosenheck & Ilan Harpaz-Rotem

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  1. Jack Tsai
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  2. Adrienne Lapidos
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  3. Robert A. Rosenheck
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  4. Ilan Harpaz-Rotem
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Correspondence to Jack Tsai.

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Tsai, J., Lapidos, A., Rosenheck, R.A. et al. Longitudinal Association of Therapeutic Alliance and Clinical Outcomes in Supported Housing for Chronically Homeless Adults. Community Ment Health J 49, 438–443 (2013). https://doi.org/10.1007/s10597-012-9518-x

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  • DOI: https://doi.org/10.1007/s10597-012-9518-x

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