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Title: An investigation into working alliance, compliance and congruence of beliefs among clients with a diagnosis of schizophrenia and their case managers
Author: Leddy, Donal
Awarding Body: University of London
Current Institution: University College London (University of London)
Date of Award: 1999
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The therapeutic relationship is central to any intervention, and although relatively neglected in clients with psychosis, there is evidence of its importance in both case management and pharmacotherapy, the two cornerstones of the care of such clients. A therapeutic relationship might have a direct beneficial effect, as well as influencing compliance with treatment. A useful model of the alliance in the case management of clients with psychosis is the working alliance as it is applicable across treatments. Central to the working alliance is a sense of agreement, or congruence between client and clinician. Achieving congruence can be especially difficult in clients diagnosed with schizophrenia, due to disagreement among clinicians and clients over understanding the disorder, the severity of the phenomena under consideration, and aspects of the interventions used. The idea that some clients lack insight into their condition both reflects and exacerbates difficulties in establishing agreement. The concept of concordance draws together congruence of beliefs about the disorder and its treatment, adherence to treatment, and the alliance between clinician and client. In the present study, the associations between alliance, adherence and congruence of beliefs were examined in a cross-sectional, correlational study. The participants were 40 clients with a diagnosis of schizophrenia, and the 10 case managers who cared for them in an inner-city multi-disciplinary community mental health team. All clients were receiving anti-psychotic medications. Measures used included the Working Alliance Inventory; the Causal Belief Questionnaire; the Insight Scale; the Manchester scale for assessing symptoms and side effects; and indirect measures of adherence with treatment, rated by the case managers. The participants were also asked open questions about helpful and unhelpful aspects of treatment. Multivariate techniques were used to analyse the data. Case manager-rated alliance was positively associated with compliance with treatments. Client-rated alliance was negatively associated with compliance with medication, and positively associated with insight. A content analysis of the open questions suggested that clients and case managers had similar views over the helpful aspects of treatment, but differed over the unhelpful. The links between alliance and compliance are complex, perhaps reflecting the rating source, and judgements and expectation of treatment. The notion of concordance as defined was not supported, but the alliance seems to be an important factor in case management.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available