Top

Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-07-2017 | Original Article

Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics

Authors: Michele L Allen, Benjamin Lê Cook, Nicholas Carson, Alejandro Interian, Martin La Roche, Margarita Alegría

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 4/2017

Abstract

Patient activation, often conceptualized as an individual trait, contributes to mental health outcomes. This study assessed the relational contributors to activation by estimating the longitudinal association of patient-provider communication and two factors of therapeutic alliance (agreement on tasks/goals and bond), with patient activation. Participants were patients (n = 264) from 13 community-based mental health clinics across the United States. In multivariate models, controlling for patients’ individual and clinical characteristics, the task/goal factor of therapeutic alliance emerged as a significant and independent predictor of greater change in patient activation scores. Improving patient activation may require addressing patient-provider interactions such as coming to collaborative agreement on the tasks/goals of care.

Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1), 1–33.CrossRefPubMed

Alegria, M., Carson, N., Flores, M., Li, X., Shi, P., Lessios, A. S., & Shrout, P. E. (2014). Activation, self-management, engagement, and retention in behavioral health care: A randomized clinical trial of the DECIDE intervention. JAMA Psychiatry, 71(5), 557–565. doi:10.1001/jamapsychiatry.2013.4519.CrossRefPubMedPubMedCentral

Alegria, M., Polo, A., Gao, S., Santana, L., Rothstein, D., Jimenez, A., & Normand, S. L. (2008). Evaluation of a patient activation and empowerment intervention in mental health care. Medical Care, 46(3), 247–256. doi:10.1097/MLR.0b013e318158af52.CrossRefPubMedPubMedCentral

Alegria, M., Sribney, W., Perez, D., Laderman, M., & Keefe, K. (2009). The role of patient activation on patient-provider communication and quality of care for US and foreign born Latino patients. Journal of General Internal Medicine, 24(Suppl 3), 534–541. doi:10.1007/s11606-009-1074-x.CrossRefPubMedPubMedCentral

Alexander, J. A., Hearld, L. R., Mittler, J. N., & Harvey, J. (2012). Patient-physician role relationships and patient activation among individuals with chronic illness. Health Services Research, 47(3 Pt 1), 1201–1223. doi:10.1111/j.1475-6773.2011.01354.x.CrossRefPubMed

Andrusyna, T. P., Tang, T. Z., DeRubeis, R. J., & Luborsky, L. (2001). The factor structure of the working alliance inventory in cognitive-behavioral therapy. Journal of Psychotherapy Practice and Research, 10(3), 173–178.PubMedPubMedCentral

Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852. doi:10.1037/0022-006X.75.6.842.CrossRefPubMed

Bambling, M., King, R., Raue, P., Schweitzer, R., & Lambert, W. (2006). Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression. Psychotherapy Research, 16(3), 317–331. doi:10.1080/10503300500268524.CrossRef

Bedi, R. P. (2006). Concept mapping the client’s perspective on counseling alliance formation. Journal of Counseling Psychology, 53(1), 26–35. doi:10.1037/0022-0167.53.1.26.CrossRef

Bernabeo, E., & Holmboe, E. S. (2013). Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Affairs, 32(2), 250–258. doi:10.1377/hlthaff.2012.1120.CrossRefPubMed

Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013). Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223–231. doi:10.1377/hlthaff.2012.1133.CrossRefPubMed

Cegala, D. J., & Post, D. M. (2009). The impact of patients’ participation on physicians’ patient-centered communication. Patient Education and Counseling, 77(2), 202–208. doi:10.1016/j.pec.2009.03.025.CrossRefPubMed

Cooper, L. A., Beach, M. C., Johnson, R. L., & Inui, T. S. (2006). Delving below the surface. Understanding how race and ethnicity influence relationships in health care. Journal of General Internal Medicine, 21(1), S21–S27. doi:10.1111/j.1525-1497.2006.00305.x.CrossRefPubMedPubMedCentral

Crits-Christoph, P., Gibbons, M. B. C., Crits-Christoph, K., Narducci, J., Schamberger, M., & Gallop, R. (2006). Can therapists be trained to improve their alliances? A preliminary study of alliance-fostering psychotherapy. Psychotherapy Research, 16(3), 268–281. doi:10.1080/10503300500268557.CrossRef

Cunningham, P. J., Hibbard, J., & Gibbons, C. B. (2011). Raising low ‘patient activation’ rates among hispanic immigrants may equal expanded coverage in reducing access disparities. Health Affairs, 30(10), 1888–1894. doi:10.1377/hlthaff.2009.0805.CrossRefPubMed

Deen, D., Lu, W. H., Rothstein, D., Santana, L., & Gold, M. R. (2011). Asking questions: The effect of a brief intervention in community health centers on patient activation. Patient Education and Counseling, 84, 257–260. doi:10.1016/j.pec.2010.07.026.CrossRefPubMed

Dunn, H., Morrison, A. P., & Bentall, R. P. (2006). The relationship between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive therapy for psychosis. Clinical Psychology & Psychotherapy, 13(3), 145–152. doi:10.1002/Cpp.481.CrossRef

Ghods, B. K., Roter, D. L., Ford, D. E., Larson, S., Arbelaez, J. J., & Cooper, L. A. (2008). Patient-physician communication in the primary care visits of African Americans and whites with depression. Journal of General Internal Medicine, 23(5), 600–606. doi:10.1007/s11606-008-0539-7.CrossRefPubMedPubMedCentral

Hanson, W. E., Curry, K. T., & Bandalos, D. L. (2002). Reliability generalization of working alliance inventory scale scores. Educational and Psychological Measurement, 62(4), 659–673. doi:10.1177/001316402128775076.CrossRef

Hartzler, B., Witkiewitz, K., Villarroel, N., & Donovan, D. (2011). Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence. Psychology of Addictive Behaviors, 25(2), 269–278. doi:10.1037/A0022869.CrossRefPubMedPubMedCentral

Hatcher, R. L., & Barends, A. W. (1996). Patients’ view of the alliance of psychotherapy: Exploratory factor analysis of three alliance measures. Journal of Consulting and Clinical Psychology, 64(6), 1326–1336.CrossRefPubMed

Hersoug, A. G., Hoglend, P., Havik, O., von der Lippe, A., & Monsen, J. (2009). Therapist characteristics influencing the quality of alliance in long-term psychotherapy. Clinical Psychology & Psychotherapy, 16(2), 100–110. doi:10.1002/cpp.605.CrossRef

Hibbard, J. H., Greene, J., Becker, E. R., Roblin, D., Painter, M. W., Perez, D. J., & Tusler, M. (2008). Racial/ethnic disparities and consumer activation in health. Health Affairs, 27(5), 1442–1453. doi:10.1377/hlthaff.27.5.1442.CrossRefPubMed

Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation result in improved self-management behaviors? Health Services Research, 42(4), 1443–1463. doi:10.1111/j.1475-6773.2006.00669.x.CrossRefPubMedPubMedCentral

Hibbard, J. H., Mahoney, E. R., Stockard, J., & Tusler, M. (2005). Development and testing of a short form of the patient activation measure. Health Services Research, 40(6 Pt 1), 1918–1930. doi:10.1111/j.1475-6773.2005.00438.x.CrossRefPubMedPubMedCentral

Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4 Pt 1), 1005–1026. doi:10.1111/j.1475-6773.2004.00269.x.CrossRefPubMedPubMedCentral

Horvath, A. O., & Greenberg, L. S. (1986). Development of the working alliance inventory. In A. O. Horvath & L. S. Greenberg (Eds.), The psychotherapeutic process: A research handbook (pp. 529–556). New York: Guilford.

Ilgen, M., Tiet, Q., Finney, J., & Moos, R. H. (2006). Self-efficacy, therapeutic alliance, and alcohol-use disorder treatment outcomes. Journal of Studies on Alcohol, 67(3), 465–472.CrossRefPubMed

Kim, S. C., Boren, D., & Solem, S. L. (2001). The kim alliance scale: Development and preliminary testing. Clinical Nursing Research, 10(3), 314–331.CrossRefPubMed

Kivlighan, D. M., & Shaughnessy, P. (1995). Analysis of the development of the working alliance using hierarchical linear modeling. Journal of Counseling Psychology, 42(3), 338–349.CrossRef

McClintock, A. S., Anderson, T., & Petrarca, A. (2015). Treatment expectations, alliance, session positivity, and outcome: An investigation of a three-path mediation model. Journal of Clinical Psychology, 71(1), 41–49. doi:10.1002/Jclp.22119.CrossRefPubMed

Mosen, D. M., Schmittdiel, J., Hibbard, J., Sobel, D., Remmers, C., & Bellows, J. (2007). Is patient activation associated with outcomes of care for adults with chronic conditions? Journal of Ambulatory Care Management, 30(1), 21–29.CrossRefPubMed

Remmers, C., Hibbard, J., Mosen, D. M., Wagenfield, M., Hoye, R. E., & Jones, C. (2009). Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? Journal of Ambulatory Care Management, 32(4), 320–327. doi:10.1097/JAC.0b013e3181ba6e77.CrossRefPubMed

Ross, E. C., Polaschek, D. L., & Wilson, M. (2011). Shifting perspectives: A confirmatory factor analysis of the working alliance inventory (short form) with high-risk violent offenders. International Journal of Offender Therapy and Comparative Criminology, 55(8), 1308–1323. doi:10.1177/0306624X11384948.CrossRefPubMed

Roter, D. L., Stewart, M., Putnam, S. M., Lipkin, M, Jr, Stiles, W., & Inui, T. S. (1997). Communication patterns of primary care physicians. JAMA, 277(4), 350–356.CrossRefPubMed

Rubin, D. B., & Schenker, N. (1986). Multiple imputation for interval estimation from simple random samples with ignorable nonresponse. Journal of the American Statistical Association, 81(394), 366–374.CrossRef

SAS Institute, I. (2008). SAS (Version 9.2). Cary, NC, USA.

Street, R. L, Jr, Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling, 74(3), 295–301. doi:10.1016/j.pec.2008.11.015.CrossRefPubMed

Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the working alliance inventory. Psychological Assessment, 1, 207–210.CrossRef

Title: Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics
Authors: Michele L Allen
Benjamin Lê Cook
Nicholas Carson
Alejandro Interian
Martin La Roche
Margarita Alegría
Publication date: 01-07-2017
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 4/2017
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-015-0655-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2017

Integrating the Electronic Health Record into Behavioral Health Encounters: Strategies, Barriers, and Implications for Practice

Factors Associated with Clinician Participation in TF-CBT Post-workshop Training Components

Evaluation of Improvement in Externalizing Behaviors and Callous-Unemotional Traits in Children with Disruptive Behavior Disorder: A 1-Year Follow Up Clinic-Based Study

Juvenile Probation Officer Self-Assessed Mental Health Competency as a Predictor of Case Management Practices

Expected Impact of Health Care Reform on the Organization and Service Delivery of Publicly Funded Addiction Health Services

Medicaid Reimbursement of Mental Health Peer-Run Organizations: Results of a National Survey