Top

Social Psychiatry and Psychiatric Epidemiology

Published in:

01-03-2015 | Original Paper

Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach

Authors: Sabine Loos, Katrin Arnold, Mike Slade, Harriet Jordan, Valeria Del Vecchio, Gaia Sampogna, Ágnes Süveges, Marietta Nagy, Malene Krogsgaard Bording, Helle Østermark Sørensen, Wulf Rössler, Wolfram Kawohl, Bernd Puschner, The CEDAR study group

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 3/2015

Abstract

Purpose

The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year.

Methods

Self-ratings of the HA by 588 people with severe mental illness who participated in a multicentre European study (CEDAR; ISRCTN75841675) were examined using latent class analysis.

Results

Four main patterns of alliance were identified: (1) high and stable (HS, 45.6 %), (2) high and increasing (HI, 36.9 %), (3) high and decreasing (HD, 11.3 %) and (4) low and increasing (LI, 6.1 %). Predictors of class membership were duration of illness, ethnicity, and education, receipt of state benefits, recovery, and quality of life.

Conclusions

Results support findings from psychotherapy research about a predominantly stable course of the helping alliance in patients with severe mental illness over time. Implications for research and practice indicate to turn the attention to subgroups with noticeable courses.

Available only for authorised users

Priebe S, Dimic S, Wildgrube C, Jankovic J, Cushing A, McCabe R (2011) Good communication in psychiatry—a conceptual review. Eur Psychiatry 26:403–407CrossRefPubMed

Quirk A, Chaplin R, Hamilton S, Lelliott P, Seale C (2013) Communication about adherence to long-term antipsychotic prescribing: an observational study of psychiatric practice. Soc Psychiatry Psychiatr Epidemiol 48:639–647CrossRefPubMed

McCabe R, Priebe S (2004) The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. Int J Soc Psychiatry 50:115–128CrossRefPubMed

Bordin E (1979) The generalizability of the psychoanalytic concept of working alliance. Psychol Psychother Theor Res Pract 16:252–260CrossRef

Horvath AO, Symonds BD (1991) Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Counsel Psychol 38:139–149CrossRef

Martin DJ, Garske JP, Davis MK (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 68:438–450CrossRefPubMed

Stiles WB, Goldsmith JZ (2010) The alliance over time. In: Muran JC, Barber JP (eds) The therapeutic alliance: an evidence-based guide to practice. Guilford Press, New York, pp 44–63

Kivlighan DM Jr, Shaughnessy P (1995) Analysis of the development of the working alliance using hierarchical linear modeling. J Counsel Psychol 42:338–349CrossRef

Kivlighan DM Jr, Shaughnessy P (2000) Patterns of working alliance development: a typology of client’s working alliance ratings. J Counsel Psychol 47:362–371CrossRef

10.

Hersoug AG, Hoglend P, Havik OE, Monsen JT (2010) Development of working alliance over the course of psychotherapy. Psychol Psychother Theor Res Pract 83:145–159CrossRef

11.

De Roten Y, Fischer M, Drapeau M, Beretta V, Kramer U, Favre N, Despland JN (2004) Is one assessment enough? Patterns of helping alliance, development and outcome. Clin Psychol Psychother 11:324–331CrossRef

12.

Kanninen K, Salo J, Punamaki RL (2000) Attachment patterns and working alliance in trauma therapy for victims of political violence. Psychother Res 10:435–449CrossRefPubMed

13.

Priebe S, McCabe R (2008) Therapeutic relationships in psychiatry: the basis of therapy or therapy in itself? Int Rev Psychiatry 20:521–526CrossRefPubMed

14.

Junghan UM, Leese M, Priebe S, Slade M (2007) Staff and patient perspectives on unmet need and therapeutic alliance in community mental health services. Br J Psychiatry 191:543–547CrossRefPubMed

15.

Chao PJ, Steffen JJ, Heiby EM (2012) The effects of working alliance and client-clinician ethnic match on recovery status. Community Ment Health J 48:91–97CrossRefPubMed

16.

Hicks AL, Deane FP, Crowe TP (2012) Change in working alliance and recovery in severe mental illness: an exploratory study. J Ment Health 21:127–134CrossRefPubMed

17.

Barrowclough C, Meier P, Beardmore R, Emsley R (2010) Predicting therapeutic alliance in clients with psychosis and substance misuse. J Nerv Ment Dis 198:373–377CrossRefPubMed

18.

Puschner B, Steffen S, Slade M, Kaliniecka H, Maj M, Fiorillo A, Munk-Jorgensen P, Larsen JI, Egerhazi A, Nemes Z, Rossler W, Kawohl W, Becker T (2010) Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): study protocol. BMC Psychiatr 10:90CrossRef

19.

First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured Clinical Interviews for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). American Psychiatric Press, Washington

20.

Moller HJ, Jager M, Riedel M, Obermeier M, Strauss A, Bottlender R (2011) The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: assessing courses, types and time stability of diagnostic classification. Eur Psychiatry 26:231–243CrossRefPubMed

21.

Slade M, Powell R, Rosen A, Strathdee G (2000) Threshold assessment grid (TAG): the development of a valid and brief scale to assess the severity of mental illness. Soc Psychiatry Psychiatr Epidemiol 35:78–85CrossRefPubMed

22.

Priebe S, Gruyters T (1993) The role of the helping alliance in psychiatric community care. A prospective study. J Nerv Ment Dis 181:552–557CrossRefPubMed

23.

Lambert MJ, Burlingame GM, Umphress V, Hansen NB, Vermeersch DA, Clouse CG, Yanchar SC (1996) The reliability and validity of the Outcome Questionnaire. Clin Psychol Psychother 3:106–116CrossRef

24.

Andresen R, Caputi P, Oades L (2013) Development of a short measure of psychological recovery in serious mental illness: the STORI-30. Australas Psychiatry 21:267–270CrossRefPubMed

25.

Weeks G, Slade M, Hayward M (2011) A UK validation of the stages of recovery instrument. Int J Soc Psychiatry 57:446–454CrossRefPubMed

26.

Gale C, Mullen R, Patterson T (2012) Re: a UK validation of the stages of recovery instrument. Int J Soc Psychiatry 58:449–450CrossRefPubMed

27.

Priebe S, Huxley P, Knight S, Evans S (1999) Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatry 45:7–12CrossRefPubMed

28.

Lambert MJ, Hannöver W, Nisslmüller K, Richard M, Kordy H (2002) Questionnaire assessing psychotherapeutic outcomes: reliability and validity of the German translation of the Outcome Questionnaire 45.2 (OQ-45.2). [Fragebogen zum Ergebnis von Psychotherapie: Zur Reliabilität und Validität der deutschen Übersetzung des Outcome Questionnaire 45.2 (OQ-45.2)]. Z Klin Psychol Psychother 31:40–46CrossRef

29.

Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P (2005) Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 8:94–104CrossRefPubMed

30.

Hagenaars JH, McCutcheon AL (2009) Applied latent class analysis. Camebridge University Press, Camebridge

31.

Nagin DS, Land KC (1993) Age, criminal careers, and population heterogeneity: specification and estimation of a nonparametric, mixed Poisson model. Criminology 31:327–362CrossRef

32.

Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis: a Monte Carlo simulation study. Struct Equ Modeling 14:535–569CrossRef

33.

Muthén LK, Muthén BO (2010) Mplus: statistical analysis with latent variables

34.

Eklund M, Hansson L (2007) Social network among people with persistent mental illness: associations with sociodemographic, clinical and health-related factors. Int J Soc Psychiatry 53:293–305CrossRefPubMed

35.

Müller B, Nordt C, Lauber C, Rössler W (2007) Changes in social network diversity and perceived social support after psychiatric hospitalization: results from a longitudinal study. Int J Soc Psychiatry 53:564–575CrossRefPubMed

36.

Velthorst E, Nieman DH, Linszen D, Becker H, de HL, Dingemans PM, Birchwood M, Patterson P, Salokangas RK, Heinimaa M, Heinz A, Juckel G, von Reventlow HG, French P, Stevens H, Schultze-Lutter F, Klosterkotter J, Ruhrmann S (2010) Disability in people clinically at high risk of psychosis. Br J Psychiatry 197:278–284CrossRefPubMed

37.

Stevens CL, Muran JC, Safran JD, Gorman BS, Winston A (2007) Levels and patterns of the therapeutic alliance in brief psychotherapy. Am J Psychother 61:109–129PubMed

38.

de Leeuw M, Van Meijel B, Grypdonck M, Kroon H (2012) The quality of the working alliance between chronic psychiatric patients and their case managers: process and outcomes. J Psychiatr Ment Health Nurs 19:1–7CrossRefPubMed

39.

Bjorngaard JH, Ruud T, Friis S (2007) The impact of mental illness on patient satisfaction with the therapeutic relationship: a multilevel analysis. Soc Psychiatry Psychiatr Epidemiol 42:803–809CrossRefPubMed

40.

Fusar-Poli P, Byrne M, Badger S, Valmaggia LR, McGuire PK (2013) Outreach and support in South London (OASIS), 2001–2011: ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis. Eur Psychiatry 28:315–326CrossRefPubMed

41.

Shick Tryon G, Collins Blackwell S, Felleman Hammel E (2007) A meta-analytic examination of client-therapist perspectives of the working alliance. Psychother Res 17:629–642CrossRef

Title: Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach
Authors: Sabine Loos
Katrin Arnold
Mike Slade
Harriet Jordan
Valeria Del Vecchio
Gaia Sampogna
Ágnes Süveges
Marietta Nagy
Malene Krogsgaard Bording
Helle Østermark Sørensen
Wulf Rössler
Wolfram Kawohl
Bernd Puschner
The CEDAR study group
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 3/2015
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-014-0963-4

At a glance: The STEP trials

Springer Medicine

Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2015

Integrating mental health screening into routine community maternal and child health activity: experience from Prevention of Mother-to-child HIV transmission (PMTCT) trial in Nigeria

The association between community environment and cognitive function: a systematic review

Caregiver distress in first-episode psychosis: the role of subjective appraisal, over-involvement and symptomatology

Erratum to: Feelings of loneliness among adults with mental disorder

The multilevel determinants of workers’ mental health: results from the SALVEO study

Common mental disorders in primary health care: differences between Latin American-born and Spanish-born residents in Madrid, Spain