The case manager's view of the helping alliance.

Although the helping alliance has been a topic of investigation in psychotherapy research for decades, few studies have examined the role of the helping alliance in assertive community treatment programs serving people with severe mental illness. In this article, we describe a series of analyses focused on the case manager's view of the helping alliance. The study addressed two primary questions: What factors facilitate a positive helping alliance in case management? What is the relationship of the helping alliance to client outcomes? Results indicated that few client variables predicted the helping alliance. Providing a wider range of services was associated with a stronger alliance at months but not at 18 months. A strong alliance at 18 months was associated with a strong alliance at 6 months. In addition, the alliance at 18 months was rated more positively for clients who were African-American and who did not have a substance use disorder. The helping alliance predicted client satisfaction, anxiety-depression, and hostility-suspicion outcomes at 6 months. However, the helping alliance did not predict any of the client outcome variables at 18 months.