title: Helping Alliance and Unmet Needs in Routine Care of People With Severe Mental Illness Across Europe: A Prospective Longitudinal Multicenter Study.
abstract: The helping alliance (HA) refers to the collaborative bond between patient and therapist, including shared goals and tasks. People with severe mental illness have a complex mixture of clinical and social needs. Using mixed-effects regression, this study examined in 588 people with severe mental illness whether an increase in the HA is associated with fewer unmet needs over time, and whether change in the HA precedes change in unmet needs. It was found that a reduction in unmet needs was slower in patients with higher HA (B = 0.04, p < 0.0001) only for patient-rated measures. Improvement in both patient-rated and staff-rated HA over time was associated with fewer subsequent patient-rated (B = -0.10, p < 0.0001) and staff-rated (B = -0.08, p = 0.0175) unmet needs. With positive changes in the HA preceding fewer unmet needs, findings provide further evidence for a causal relationship between alliance and outcome in the treatment of people with severe mental illness.
authors.affiliation: *Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg; †Institute of Epidemiology and Medical Biometry, Ulm University, Germany; ‡Section for Recovery, Institute of Psychiatry, King's College London; §Institute of Mental Health, University of Nottingham, UK; ∥Department of Psychiatry, University of Naples SUN, Italy; ¶Department of Psychiatry, University of Debrecen Medical and Health Science Center, Hungary; **Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Denmark; and ††Centre for Social Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
authors.forename: Katrin
authors.initials: K
authors.lastname: Arnold
authors.forename: Sabine
authors.initials: S
authors.lastname: Loos
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mayer
authors.forename: Eleanor
authors.initials: E
authors.lastname: Clarke
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiorillo
authors.forename: Valeria
authors.initials: V
authors.lastname: Del Vecchio
authors.forename: Anikó
authors.initials: A
authors.lastname: Égerházi
authors.forename: Tibor
authors.initials: T
authors.lastname: Ivánka
authors.forename: Pøvl
authors.initials: P
authors.lastname: Munk-Jørgensen
authors.forename: Malene
authors.initials: M
authors.lastname: Krogsgaard Bording
authors.forename: Wolfram
authors.initials: W
authors.lastname: Kawohl
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.forename: Bernd
authors.initials: B
authors.lastname: Puschner
mesh_terms: D000328:Adult; D005060:Europe; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D000071066:Patient Reported Outcome Measures; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000592:standards*; D012720:Severity of Illness Index; D055815:Young Adult