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Related Experiment Videos

Client outcomes and the working alliance in assertive community treatment programs.

Robert J Calsyn1, Gary A Morse, W Dean Klinkenberg

  • 1Psychology Department, University of Missouri-St. Louis, St. Louis, MO 63121, USA. robert_calsyn@umsl.edu

Care Management Journals : Journal of Case Management ; the Journal of Long Term Home Health Care
|November 22, 2005
PubMed
Summary

The working alliance showed minimal impact on treatment outcomes for individuals with severe mental illness and substance use disorders. This study found little correlation between alliance strength and client results in community treatment settings.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Addiction Medicine

Background:

  • The working alliance is crucial in therapeutic relationships, but its impact on outcomes for severe mental illness (SMI) and co-occurring substance use disorders (SUDs) is not fully understood.
  • Assertive Community Treatment (ACT) and integrated ACT models are used to treat this complex population.

Purpose of the Study:

  • To investigate the relationship between the working alliance and treatment outcomes in clients receiving ACT or integrated ACT.
  • To assess if the strength of the client-case manager alliance predicts outcomes such as housing stability, psychiatric distress, and substance use.

Main Methods:

  • Ninety-eight participants with SMI and SUD were enrolled in either ACT or integrated ACT.
  • The Working Alliance Inventory measured alliance strength from client and case manager perspectives at 3 and 15 months.

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  • Outcomes included housing stability, psychiatric distress, psychiatric symptoms, and alcohol/drug use.

    • Main Results:

    • A low number of significant correlations (4 out of 24) were found between working alliance measures and client outcomes.
    • This suggests a weak association between the therapeutic alliance strength and treatment success in this population.
    • Findings were consistent across different time points (3 and 15 months).

    Conclusions:

    • The working alliance may play a limited role in determining treatment outcomes for individuals with co-occurring SMI and SUDs receiving ACT.
    • Further research is needed to identify key factors that drive successful outcomes in integrated treatment settings for this population.