Community Mental Health Journal

, Volume 42, Issue 2, pp 161–175 | Cite as

Predictors of the Working Alliance in Assertive Community Treatment

  • Robert J. Calsyn
  • W. D. Klinkenberg
  • Gary A. Morse
  • Matthew R. Lemming
Article

Abstract

Past research has found that a positive working alliance between clients and their case managers is modestly correlated with client outcomes. The current study tried to identify the predictors of the working alliance in a sample of 115 clients who were receiving services from Assertive Community Treatment (ACT) teams. All of the clients suffered from severe mental illness, had a substance use disorder and were homeless at baseline. Both the client’s rating and the case manager’s rating of the working alliance were assessed at 3 months and 15 months post baseline. Client characteristics, particularly motivation to change, explained more of the variance of the client’s rating of the alliance than treatment variables or client change on the outcome variables. On the other hand, treatment variables (e.g., the amount of transportation services provided) and client change on the outcome variables explained more of the variance of the case manager’s rating of the alliance.

Keywords

working alliance case manager predictors assertive community treatment. 

References

  1. Belding M. A., Iguchi M. Y., Morral A. R., McLellan A. T. (1997). Assessing the helping alliance and its impact in the treatment of opiate dependence. Drug and Alcohol Dependence 48: 51–59CrossRefPubMedGoogle Scholar
  2. Blume A. W., Schmaling K. B. (1997). Specific classes of symptoms predict readiness to change scores among dually diagnosed patients. Addictive Behaviors 22(5): 625–630CrossRefPubMedGoogle Scholar
  3. Calsyn R. J., Morse G. A., Allen G. (1999). Predicting the helping alliance with people with a psychiatric disability. Psychiatric Rehabilitation Journal 22(3): 283–287Google Scholar
  4. Calsyn, R. J., Morse, G. A., Klinkenberg, W. D., & Lemming, M. R. (2005). Client outcomes and the working alliance in assertive treatment programs. Journal of Case Management, 5, 199–202CrossRefGoogle Scholar
  5. Carey K. B., Cocco K. M., Simons J. S. (1996). Concurrent validity of clinicians’ ratings of substance abuse among psychiatric outpatients. Psychiatric Services 47(8): 842–847PubMedGoogle Scholar
  6. Draine J., Solomon P. (1996). Case manager alliance with clients in an older cohort. Community Mental Health Journal 32: 125–134CrossRefPubMedGoogle Scholar
  7. First M. B., Gibbon M., Spitzer R. L., Williams J. (1996). User’s guide for the structured clinical interview for DSM IV axis I disorders (SCID). Biometrics Research Department, New York State Psychiatric Institute, NY, NYGoogle Scholar
  8. Horvath A. O., Bedi R. P. (2002). The alliance. In: Norcross J. C. (eds), Psychotherapy relationships that work: therapist contributions and responsiveness to patients. University Press, OxfordGoogle Scholar
  9. Klinkenberg W. D., Calsyn R. J., Morse G. A. (2002). The case manager’s view of the helping alliance. Care Management Journals 3: 120–126CrossRefPubMedGoogle Scholar
  10. 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): 569–578CrossRefPubMedGoogle Scholar
  11. Lukoff O., Neuchterlein K., Ventura J. (1986). Manual for the expanded Brief Psychiatric Rating Scale. Schizophrenia Bulletin 13: 261–276Google Scholar
  12. 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): 438–450CrossRefPubMedGoogle Scholar
  13. Morse, G. A., Calsyn, R. J., Klinkenberg, W. D., Halminiak, T. W., Wolff, N., Drake, R. E., Yonker, R. D., Lama, G., Lemming, M. R., & McCudden, S. (in press). Treating homeless clients with severe mental illness and substance use disorders: costs and outcomes, Community Mental Health Journal Google Scholar
  14. Neale M. S., Rosenheck R. A. (1995). Therapeutic alliance and outcome in a VA intensive case management program. Psychiatric Services 46(7): 719–721PubMedGoogle Scholar
  15. Priebe S., Gruyters T. (1993). The role of the helping alliance in psychiatric community care: A prospective study. The Journal of Nervous and Mental Disease 181: 552–557PubMedCrossRefGoogle Scholar
  16. Rollnick S., Heather N., Gold R., Hall W. (1992). Development of a short ‘readiness to change’ questionnaire for use in brief opportunistic interventions among excessive drinkers. British Journal of Addiction, 87: 743–754PubMedCrossRefGoogle Scholar
  17. Solomon P., Draine J., Delaney M. A. (1995). The working alliance and consumer case management. Journal of Mental Health Administration 22(2): 126–134PubMedCrossRefGoogle Scholar
  18. Teague G. B., Bond G. R., Drake R. E., (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry 68: 216–232PubMedCrossRefGoogle Scholar
  19. Tracey T. J., Kokotovic A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment: A journal of consulting and clinical psychology 1: 207–210Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Robert J. Calsyn
    • 1
  • W. D. Klinkenberg
  • Gary A. Morse
  • Matthew R. Lemming
  1. 1.University of Missouri-St. LouisSt. LouisUSA

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