title: Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach.
abstract: OBJECTIVE
  The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year.
  
  
  METHODS
  Self-ratings of the HA by 588 people with severe mental illness who participated in a multicentre European study (CEDAR; ISRCTN75841675) were examined using latent class analysis.
  
  
  RESULTS
  Four main patterns of alliance were identified: (1) high and stable (HS, 45.6 %), (2) high and increasing (HI, 36.9 %), (3) high and decreasing (HD, 11.3 %) and (4) low and increasing (LI, 6.1 %). Predictors of class membership were duration of illness, ethnicity, and education, receipt of state benefits, recovery, and quality of life.
  
  
  CONCLUSIONS
  Results support findings from psychotherapy research about a predominantly stable course of the helping alliance in patients with severe mental illness over time. Implications for research and practice indicate to turn the attention to subgroups with noticeable courses.
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany, sabine.loos@uniklinik-ulm.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Loos
authors.forename: Katrin
authors.initials: K
authors.lastname: Arnold
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
authors.forename: Harriet
authors.initials: H
authors.lastname: Jordan
authors.forename: Valeria
authors.initials: V
authors.lastname: Del Vecchio
authors.forename: Gaia
authors.initials: G
authors.lastname: Sampogna
authors.forename: Ágnes
authors.initials: Á
authors.lastname: Süveges
authors.forename: Marietta
authors.initials: M
authors.lastname: Nagy
authors.forename: Malene
authors.initials: M
authors.lastname: Krogsgaard Bording
authors.forename: Helle
authors.initials: H
authors.lastname: Østermark Sørensen
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.forename: Wolfram
authors.initials: W
authors.lastname: Kawohl
authors.forename: Bernd
authors.initials: B
authors.lastname: Puschner
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*