Abstract
The helping alliance (HA) refers to the collaborative bond between patient and therapist, including shared goals and tasks. People with severe mental illness have a complex mixture of clinical and social needs. Using mixed-effects regression, this study examined in 588 people with severe mental illness whether an increase in the HA is associated with fewer unmet needs over time, and whether change in the HA precedes change in unmet needs. It was found that a reduction in unmet needs was slower in patients with higher HA (B = 0.04, p < 0.0001) only for patient-rated measures. Improvement in both patient-rated and staff-rated HA over time was associated with fewer subsequent patient-rated (B = -0.10, p < 0.0001) and staff-rated (B = -0.08, p = 0.0175) unmet needs. With positive changes in the HA preceding fewer unmet needs, findings provide further evidence for a causal relationship between alliance and outcome in the treatment of people with severe mental illness.
Highlights
Helping alliance (HA) refers to the collaborative bond between patient and therapist including shared goals and tasks (Ardito and Rabellino, 2011; Bordin, 1979) and has been consistently found to predict outcome of psychotherapy (Horvath et al, 2011; Horvath and Symonds, 1991; Martin et al, 2000)
Unmet needs decreased over time, with patients indicating fewer unmet needs than staff (Fig. 1). ### insert Fig. 1 about here ### As shown in Table 2, at baseline patients with an average Helping Alliance Scale (HAS)-P score reported 3.13 unmet needs which decreased by 0.36 points with each unit that participants scored above the average HAS-P score
An increase of the helping alliance (HA) was associated with fewer unmet needs at the assessment point (B=-0.10), and there was a significant improvement in patient-rated unmet needs over time (B=-0.13)
Summary
Helping alliance (HA) refers to the collaborative bond between patient and therapist including shared goals and tasks (Ardito and Rabellino, 2011; Bordin, 1979) and has been consistently found to predict outcome of psychotherapy (Horvath et al, 2011; Horvath and Symonds, 1991; Martin et al, 2000). An exception is a study which reported that patient- and staff-rated HA predicted subsequent clinical improvement when controlling for prior symptom change (De Bolle et al, 2010). Another study, using a multilevel model controlled for confounders, showed that a reduction in outcome (unmet needs) preceded an increase of the patient-, but not of the staff-rated HA (Junghan et al, 2007)
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