title: Examining the Relationship between Choice, Therapeutic Alliance and Outcomes in Mental Health Services.
abstract: BACKGROUND
  Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance.
  
  
  METHODS
  The study sample of 396 participants completed a survey measuring choice, therapeutic alliance, recovery, quality of life and functioning. Multivariate analyses examined choice as a predictor of outcomes, and Sobel tests assessed alliance as a mediator.
  
  
  RESULTS
  Choice variables predicted recovery, quality of life and perceived outcomes. Sobel tests indicated that the relationship between choice and outcome variables was mediated by therapeutic alliance.
  
  
  CONCLUSIONS
  The study demonstrates that providing more choice and opportunities for collaboration within services does improve consumer outcomes. The results also show that collaboration is dependent on the quality of the relationship between the provider and consumer.
authors.affiliation: Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA. victoria.stanhope@nyu.edu.
authors.forename: Victoria
authors.initials: V
authors.lastname: Stanhope
authors.affiliation: Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA. Stacey.barrenger@nyu.edu.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Barrenger
authors.affiliation: Department of Rehabilitation, Temple University, 1700 N. Broad Street, Suite 304, Philadelphia, PA 19122, USA. msalzer@temple.edu.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Salzer
authors.affiliation: School of Social Policy and Practice, Caster Building, University of Pennsylvania, Philadelphia, PA 19104, USA. marcuss@sp2.upenn.edu.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Marcus