Although supportive relationship factors have been widely acknowledged as pivotal in the interaction between clients with severe mental illness and their case managers, there has been almost no systematic study of this phenomenon, a lack which hinders evaluative research efforts and service development in case management. Drawing upon the voluminous and promising findings on the alliance concept in psychotherapy research, including research using different types of treatment, for clients with a broad range of diagnoses, including borderline personality disorders, drug addiction, and schizophrenia, this exploratory pilot study will use a prospective, cohort design to examine the development of the alliance between 70 clients with schizophrenia or schizo-effective diagnoses and their intensive case managers. Clients will be recruited from base service units in Montgomery, Delaware, Chester and Bucks counties in Pennsylvania, that provide intensive case management services (ICM) for clients with severe and persistent mental illness. The main measures will be 3 self-report alliance instruments -- The working Alliance Inventory (WAI), The Barrett Lennard Relationship Inventory (BL), and the Penn Helping Relationship Questionnaire (HAq), each completed by clients and their case managers and adapted for use in ICM. Clients and their case managers will be assessed at 3 months, 6 months, 6 months plus 2 weeks and 9 months.
The aim of the study are:
Aim 1 -- to document the reliability and validity of client and case manager versions of the 3 alliance instruments;
Aim 2 -- to document the rate of development of the alliance as measured by client and case manager versions of the instruments;
Aim 3 -- to document selected client and case manager correlates of the alliance instruments;
and Aim 4 -- to explore the prognostic capacity of the alliance instruments to assess client functioning; treatment participation; medication compliance and attitudes toward medication compliance; client satisfaction with ICM; and client assessment of subjective quality of life at the end of 9 months in ICM.
| Bressi Nath, Sara; Alexander, Leslie B; Solomon, Phyllis L (2012) Case managers' perspectives on the therapeutic alliance: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 47:1815-26 |
| Solomon, Phyllis; Alexander, Leslie; Uhl, Stacey (2010) The relationship of case managers' expressed emotion to clients' outcomes. Soc Psychiatry Psychiatr Epidemiol 45:165-74 |
| Buck, Page Walker; Alexander, Leslie B (2006) Neglected voices: consumers with serious mental illness speak about intensive case management. Adm Policy Ment Health 33:470-81 |
| Coffey, Darla Spence (2003) Connection and autonomy in the case management relationship. Psychiatr Rehabil J 26:404-12 |
