An exploration of the working alliance in mental health case management

The working alliance between clients and helpers has been identified as a common factor of treatment effectiveness, yet very little research has explored variables associated with working alliance between mental health case managers and their consumers. This study explored the potential covariates of working alliance within community mental health case management. Specifically, the study explored to what degree the case manager is related to consumer perceptions of working alliance, to what degree consumers' perceived mental illness stigma is related to working alliance, and the extent to which the relationship between perceived stigma and working alliance is different for different case managers. Cross-sectional data were collected from 160 people receiving case management services and were analyzed using hierarchical linear modeling. Case managers accounted for about 11% of the variance in working alliance scores, which represents a moderate effect. Perceived stigma approached a statistically significant relationship with working alliance. The interaction between case managers and stigma was significantly related to working alliance. Case managers are an important source of variance in the relationship between stigma and working alliance. Future attempts to study working alliance should include case managers and consumers' perceived stigma as independent variables. © 2010 National Association of Social Workers.