Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Research

The foundations of the working alliance in assertive community treatment teams

Authors: M. van Haaren, S. de Jong, D. P. K. Roeg

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

In this study, we aimed to identify and define the fundamental components of the working alliance in multidisciplinary (Flexible) Assertive Community Treatment teams with shared caseloads, in order to support their daily practice and further research.

Methods

After reviewing the literature, concept mapping with professionals and clients was used to define the working alliance in (F) ACT teams. The resulting concept maps formed the basis for the working alliance assessment instrument, which was pilot tested with professionals and clients through cognitive interviews with a think-aloud procedure.

Results

The study led to the development of a twenty five-item assessment instrument to evaluate working alliances in multidisciplinary teams (WAM) that was comprised of three subscales: bond, task/goal and team. Two different versions were developed for clients and professionals.

Conclusions

The WAM instrument was developed to determine the quality of the working alliance in (F) ACT teams. Future research will focus on testing its psychometric properties and predictive value.

Available only for authorised users

Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M, et al. Intensive case management for severe mental illness. Cochrane Database Syst Rev. 2017;1(1). https://doi.org/10.1002/14651858.CD007906.pub3.

van Veldhuizen JR, Bähler M, Polhuis D, et al. (eds): Handboek FACT. Utrecht, De Tijdstroom, 2008.

van Veldhuizen JR. FACT: a Dutch version of ACT. Community Ment Health J. 2007;43(4):421–33. https://doi.org/10.1007/s10597-007-9089-4.CrossRefPubMed

Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M. Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ. 2007;335(7615):336–42. https://doi.org/10.1136/bmj.39251.599259.55.CrossRefPubMedPubMedCentral

Coldwell CM, Bender WS. The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis. Am J Psychiatry. 2007;164(3):393–9. https://doi.org/10.1176/ajp.2007.164.3.393.CrossRefPubMed

Drukker M, Maarschalkerweerd M, Bak M, Driessen G, à Campo J, de Bie A, et al. A real-life observational study of the effectiveness of FACT in a Dutch mental health region. BMC Psychiatry. 2008;8(1):93. https://doi.org/10.1186/1471-244X-8-93.CrossRefPubMedPubMedCentral

Drukker M, Visser E, Sytema S, van Os J. Flexible assertive community treatment, severity of symptoms and psychiatric health service use, a real life observational study. Clin Pract Epidemiol Ment Health. 2013;9(1):202–9. https://doi.org/10.2174/1745017901309010202.CrossRefPubMedPubMedCentral

van Vugt MD, Kroon H, Delespaul PAEG, Dreef FG, Nugter A, Roosenschoon BJ, et al. Assertive community treatment in the Netherlands: outcome and model fidelity. La Revue canadienne de psychiatry. 2011;56(3):154–60. https://doi.org/10.1177/070674371105600305.CrossRef

Ahn HN, Wampold BE. Where oh where are the specific ingredients? A meta-analysis of component studies in counseling and psychotherapy. J Couns Psychol. 2001;48(3):251–7. https://doi.org/10.1037/0022-0167.48.3.251.CrossRef

10.

Emmerink PMJ, Roeg DPK. Predictors of quality of life of people receiving intensive community-based care: a cross-sectional study. Qual Life Res. 2016;25(2):457–64. https://doi.org/10.1007/s11136-015-1093-5.CrossRefPubMed

11.

Hafkenscheid A. De therapeutische relatie. Utrecht: de Tijdstroom; 2014.

12.

Horvath AO, Bedi RP. The alliance. In: Norcross JC, editor. Psychotherapy relationships that work: therapist contributions and responsiveness. New York: Oxford University Press; 2002.

13.

Horvath AO, Del Re AC, Flückiger C, et al. Alliance in individual psychotherapy. In: Norcross JC, editor. Psychotherapy relationships that work: evidence based responsiveness (2^nd edition). New York: Oxford University Press; 2011. https://doi.org/10.1093/acprof:oso/9780199737208.003.0002.CrossRef

14.

Hunsley J, Di Guilio G. Dodo bird, phoenix, or urban legend? The question of psychotherapy equivalence. The Scientific Review of Mental Health Practice: Objective Investigations of Controversial and Unorthodox Claims in Clinical Psychology, Psychiatry, and Social Work. 2002;1:11–22.

15.

Keijsers GPJ. Het grote psychotherapiedebat. Gedragstherapie. 2014;47:148–72.

16.

Keijsers GPJ, van Minnen A, Verbraak M, et al. Toepassing van protocollaire behandelingen bij psychische stoornissen. In: Keijsers GPJ, Van Minnen A, Verbraak M, et al., editors. Protocollaire behandelingen voor volwassenen met psychische klachten 1. Amsterdam: Boom; 2017.

17.

Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000;68(3):438–50. https://doi.org/10.1037/0022-006X.68.3.438.CrossRefPubMed

18.

Wampold BE. The research evidence for the common factors models: a historically situated perspective. In: Duncan BL, editor. The heart and soul of change: delivering what works in therapy. Miller SD: Wampold BE et al. American Psychological Association; 2010. https://doi.org/10.1037/12075-002.CrossRef

19.

Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy. 1979;16(3):252–60. https://doi.org/10.1037/h0085885.CrossRef

20.

Baldwin SA, Wampold BE, Imel ZE. Untangling the Alliance-outcome correlation: exploring the relative importance of therapist and patient variability in the Alliance. J Consult Clin Psych. 2007;75(6):842–52. https://doi.org/10.1037/0022-006X.75.6.842.CrossRef

21.

Horvath AO, Greenberg LS. Development and validation of the working Alliance inventory. J Couns Psychol. 1989;36(2):223–33. https://doi.org/10.1037/0022-0167.36.2.223.CrossRef

22.

Fakhoury WKH, White I, Priebe S, et al. Be good to your patient. How the therapeutic relationship in the treatment of patients admitted to assertive outreach affects rehospitalisation. J Nerv Ment Dis. 2007;195(9):789–91. https://doi.org/10.1097/NMD.0b013e318142cf5e.CrossRefPubMed

23.

Gehrs M, Goering P. The relationship between the working alliance and rehabilitation outcomes of schizophrenia. Psychosoc Rehabil J. 1994;18(2):43–54. https://doi.org/10.1037/h0095517.CrossRef

24.

Malinovsky I, Lehrer P, Silverstein SM, Shankman SA, O'Brien W, Samuelson T, et al. An empirical evaluation of recovery transformation at a large community psychiatric rehabilitation organization. Psychol Serv. 2013;10(4):428–41. https://doi.org/10.1037/a0032747.CrossRefPubMed

25.

Neale MS, Rosenheck RA. Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv. 1995;46(7):719–21. https://doi.org/10.1176/ps.46.7.719.CrossRefPubMed

26.

Solomon P, Draine J, Delaney MA. The working alliance and consumer case management. J Ment Health Adm. 1995;22(2):126–34. https://doi.org/10.1007/BF02518753.CrossRefPubMed

27.

Buck PW, Alexander L. Neglected voices: consumers with serious mental illness speak about intensive case management. Admin Pol Ment Health. 2006;33(4):470–81. https://doi.org/10.1007/s10488-005-0021-3.CrossRef

28.

Allness DJ, Knoedler WH. A manual for ACT start-up: based on the PACT model of community treatment for persons with severe and persistent mental illnesses. 2nd. ed. National Alliance on Mental Illness: Arlington VA; 2003.

29.

Thornicroft G. Testing and retesting assertive community treatment. Psychiatr Serv. 2000;51(6):703. https://doi.org/10.1176/appi.ps.51.6.703.CrossRefPubMed

30.

Gunderson JG, Links PS. Borderline personality disorder: a clinical guide. Washington DC: American Psychiatric Publishers; 2008.

31.

Calsyn RJ, Morse GA, Klinkenberg WA, et al. Client outcomes and the working alliance in assertive community treatment programs. Care Management Journals. 2004;5(4):199–202. https://doi.org/10.1891/cmaj.2004.5.4.199.CrossRefPubMed

32.

Calsyn RJ, Klinkenberg WD, Morse GA, Lemming MR. Predictors of the working alliance in assertive community treatment. Community Ment Health J. 2006;42(2):161–75. https://doi.org/10.1007/s10597-005-9022-7.CrossRefPubMed

33.

Calsyn RJ, Morse GA, Allen G. Predicting the helping alliance with people with a psychiatric disability. Psychiatr Rehabil J. 1999;22(3):283–7. https://doi.org/10.1037/h0095232.CrossRef

34.

Cunningham J, Calsyn RJ, Burger GK, Morse GA, Klinkenberg WD. Client outcomes and the working alliance in the client-casemanager relationship: a causal analysis. Care Management Journals. 2007;8(3):106–12. https://doi.org/10.1891/152109807781753745.CrossRefPubMed

35.

Klinkenberg WD, Calsyn RJ, Morse GA. The case manager’s view of the helping alliance. Care Management Journals. 2002;3(3):120–5. https://doi.org/10.1891/cmaj.3.3.120.57441.CrossRefPubMed

36.

Klinkenberg WD, Calsyn RJ, Morse GA. The helping alliance in case management for homeless persons with severe mental illness. Community Ment Health J. 1998;34(6):569–78. https://doi.org/10.1023/A:1018758917277.CrossRefPubMed

37.

Trochim WM. An introduction to concept mapping for planning and evaluation. Eval Program Plann. 1989;12(1):1–16. https://doi.org/10.1016/0149-7189(89)90016-5.CrossRef

38.

Roeg DPK, van de Goor LAM, Garretsen HFL. Towards structural quality indicators for intensive community-based care programmes for substance abusers. Community Ment Health J. 2008;44(6):405–15. https://doi.org/10.1007/s10597-008-9143-x.CrossRefPubMed

39.

Roeg DPK, van de Goor LAM, Garretsen HFL. Towards quality indicators for assertive outreach programmes for severely impaired substance abusers: concept mapping with Dutch experts. Qual Assur Health Care. 2005;17(3):203–8. https://doi.org/10.1093/intqhc/mzi031.CrossRef

40.

Burke JG, O’Campo P, Peak GL, Gielen AC, McDonnell KA, Trochim WMK. An introduction to concept mapping as a participatory public health research method. Qual Health Res. 2005;15(10):1392–410. https://doi.org/10.1177/1049732305278876.CrossRefPubMed

41.

Nabitz U, van den Brink W, Jansen P. Using concept mapping to design an indicator framework for addiction treatment centres. Qual Assur Health Care. 2005;17(3):193–201. https://doi.org/10.1093/intqhc/mzi037.CrossRef

42.

van Bon-Martens MJH, Achterberg PW, van de Goor IAM, van Oers HAM. Towards quality criteria for regional public health reporting: concept mapping with Dutch experts. Eur J Pub Health. 2011;22(3):337–42. https://doi.org/10.1093/eurpub/ckr016.CrossRef

43.

Severens P: Manual Ariadne 3.0, 2015. www.minds21.org/

44.

Ahearn EP. The use of visual analog scales in mood disorders: a critical review. J Psychiatr Res. 1995;31(5):569–79. https://doi.org/10.1016/S0022-3956(97)00029-0.CrossRef

45.

Hasson D, Arnetz BB: Validation and findings comparing VAS vs. Likert scales for psychosocial measurements. Int Electron J Health Educ 2005;8:178–192.

46.

Voutilainen A, Pitkäaho T, Kvist T, Vehviläinen-Julkunen K. How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. J Adv Nurs. 2016;72(4):946–57. https://doi.org/10.1111/jan.12875.CrossRefPubMed

47.

Campanelli P. Testing survey questions. In: De Leeuw ED, editor. International handbook of survey methodology. Hox JJ: Dillman DA; 2008. www.eam-online.org.

48.

Martin E: Survey Questionnaire Construction, in Research Report Series. Survey Methodology. Washington, U.S. Census Bureau, 2006.

49.

Elvins R, Green J. The conceptualization and measurement of therapeutic alliance: an empirical review. Clin Psychol Rev. 2008;28(7):1167–87. https://doi.org/10.1016/j.cpr.2008.04.002.CrossRefPubMed

50.

Angell B, Mahoney C. Reconceptualizing the case management relationship in intensive treatment. A study of staff perceptions and experiences. Admin Pol Ment Health. 2007;34(2):172–88. https://doi.org/10.1007/s10488-006-0094-7.CrossRef

51.

McGuire-Sieckus R, McCabe R, Catty J, et al. A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychol Med. 2007;37(1):85–95. https://doi.org/10.1017/S0033291706009299.CrossRef

52.

Blais MA. Development of an inpatient treatment Alliance scale. J Nerv Ment Dis. 2004;192(7):487–93. https://doi.org/10.1097/01.nmd.0000131911.53489.af.CrossRefPubMed

53.

Goodwin I, Holmes G, Cochrane R, Mason O. The ability of adult mental health services to meet clients’ attachment needs: the development and implementation of the service attachment questionnaire. Psychol Psychother. 2003;76(2):145–61. https://doi.org/10.1348/147608303765951186.CrossRefPubMed

54.

Agnew-Davies R, Stiles WB, Hardy GE, Barkham M, Shapiro DA. Alliance structure assessed by the Agnew relationship measure (ARM). Br J Clin Psychol. 1998;37(2):155–72. https://doi.org/10.1111/j.2044-8260.1998.tb01291.x.CrossRefPubMed

55.

Barrowclough C, Meier P, Beardmore R, Emsley R. Predicting therapeutic alliance in clients with psychosis and substance misuse. J Nerv Ment Dis. 2010;198(5):373–7. https://doi.org/10.1097/NMD.0b013e3181da4d4e.CrossRefPubMed

56.

Howgego IM, Yellowlees P, Owen C, Meldrum L, Dark F. The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Aust N Z J Psychiatry. 2003;37(2):169–83. https://doi.org/10.1046/j.1440-1614.2003.01131.x.CrossRefPubMed

57.

Ruchlewska A, Kamperman AM, van der Gaag M, Wierdsma AI, Mulder NCL. Working alliance in patients with severe mental illness who need a crisis intervention plan. Community Ment Health J. 2016;52(1):102–8. https://doi.org/10.1007/s10597-015-9839-7.CrossRefPubMed

58.

Theodoridou A, Schlatter F, Ajdacic V, Rössler W, Jäger M. Therapeutic relationship in the context of perceived coercion in a psychiatric population. Psychiatry Res. 2012;200(2-3):939–44. https://doi.org/10.1016/j.psychres.2012.04.012.CrossRefPubMed

59.

Skatun KC, Kaufmann T, Trung Doan N, et al. Consistent functional connectivity alterations in schizophrenia spectrum disorder: a multisite study. Schizophr Bull (Bp). 2017;43(4):914–24. https://doi.org/10.1093/schbul/sbw145.CrossRef

60.

Hasson-Ohayon I, Kravetz S, Lysaker PH. The special challenges of psychotherapy with persons with psychosis: intersubjective metacognitive model of agreement and shared meaning. Clin Psychol Psychother. 2017;24(2):428–40. https://doi.org/10.1002/cpp.2012.CrossRefPubMed

Title: The foundations of the working alliance in assertive community treatment teams
Authors: M. van Haaren
S. de Jong
D. P. K. Roeg
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03563-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The foundations of the working alliance in assertive community treatment teams

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

The link between problematic internet use, problematic gaming, and psychological distress: does sleep quality matter?

Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy

Cortical thickness distinguishes between major depression and schizophrenia in adolescents

Depression and HIV associated neurocognitive disorders among HIV infected adults in rural southwestern Uganda: a cross-sectional quantitative study

Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder

Common mental disorders among seasonal migrant farmworkers in Northwest Ethiopia