Client outcomes and the working alliance in the client-case manager relationship: a causal analysis

This study investigated the causal relationship between the working alliance and client outcomes in the client-case manager relationship. All 162 study participants received services fiom a case manager who worked as a member of an assertive community treatment team. All participants had both a substance use disorder and a diagnosis of severe mental illness and were homeless at baseline. A brief form of the Working Alliance Inventory (WAI) was used to measure the working alliance after 3 and 15 months of treatment. The Brief Psychiatric Rating Scale was used to measure psychiatric symptoms at baseline, 9, and 18 months. Days per month that clients used alcohol or illegal drugs was also assessed at baseline, 9, and 18 months. The data were analyzed using structural equation modeling (SEM). The correlations between the working alliance and the outcome measures were lower than similar correlations obtained in studies investigating the psychotherapy relationship. The SEM analyses revealed little or no causal relationship between the working alliance and client outcome in this sample.