The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management

Howgego, Irene M., Yellowlees, Peter, Owen, Cathy, Meldrum, Lenore and Dark, Frances (2003) The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Australian And New Zealand Journal of Psychiatry, 37 2: 169-183. doi:10.1046/j.1440-1614.2003.01131.x


Author Howgego, Irene M.
Yellowlees, Peter
Owen, Cathy
Meldrum, Lenore
Dark, Frances
Title The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management
Journal name Australian And New Zealand Journal of Psychiatry   Check publisher's open access policy
ISSN 0004-8674
1440-1614
Publication date 2003-04-01
Sub-type Article (original research)
DOI 10.1046/j.1440-1614.2003.01131.x
Volume 37
Issue 2
Start page 169
End page 183
Total pages 15
Editor Professor Sidney Bloch
Place of publication Carlton, Victoria
Publisher Blackwell Publishing Asia
Collection year 2003
Language eng
Subject C1
321021 Psychiatry
730211 Mental health
Formatted abstract
Objective: The aim of this review was to examine the level of evidence supporting the assumed link between a positive therapeutic alliance among patients and case managers and effective outcome for patients with a mental illness who are managed in community mental health services.

Method:
MedLine, PsychINFO and Social Sciences Index search of articles from 1986 to 2001 returned 84 articles and two texts. Inclusion criteria were the use of validated measures and relevance to psychiatry and community case management.

Results: A definite correlation exists in the psychotherapy literature between the therapeutic relationship and improved outcomes, with its potential as a prognostic indicator acknowledged. Attempts to apply the concept to patients outside the field of psychotherapy have been slow, although expansion of the concept to other forms of change-inducing therapy was a current trend. Issues of definition, quantification and measurement of the relationship caused rigorous debate in the literature. Case management research demonstrating the importance of the therapeutic relationship and 'goodness-of-fit' between patients and case managers was sparse with no published Australian studies.

Conclusions: The level of evidence supporting the link between the therapeutic alliance of patients with mental illness and improved outcomes although sparse is encouraging. It indicates the potential of the alliance as a predictor of outcome for patients engaged in case management services in community mental health. Research to determine the role and effectiveness of the alliance in the patient/case manager dyad is needed to define this potential. Effectiveness of clinical practice in the case management field could be enhanced if research findings confirmed the genesis and value of the alliance in case management. Focus on relationship strategies as a clinical tool gives the clinician and service provider a potential vehicle for promoting partnerships with the seriously mentally ill person in managing their illness and optimizing their strengths in the community.
Keyword Case Management
Community
Mental Health
Working Alliance
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Medicine Publications
2004 Higher Education Research Data Collection
 
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Created: Wed, 15 Aug 2007, 12:37:16 EST