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J. Pers. Med. 2013, 3(3), 191-202;

Examining the Relationship between Choice, Therapeutic Alliance and Outcomes in Mental Health Services

Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA
Department of Rehabilitation, Temple University, 1700 N. Broad Street, Suite 304, Philadelphia, PA 19122, USA
School of Social Policy and Practice, Caster Building, University of Pennsylvania, Philadelphia, PA 19104, USA
Author to whom correspondence should be addressed.
Received: 3 July 2013 / Revised: 13 August 2013 / Accepted: 14 August 2013 / Published: 20 August 2013
PDF [416 KB, uploaded 20 August 2013]


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. Method: 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. Implications: 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. View Full-Text
Keywords: self-determination; therapeutic alliance; choice; mental health services self-determination; therapeutic alliance; choice; mental health services
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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MDPI and ACS Style

Stanhope, V.; Barrenger, S.L.; Salzer, M.S.; Marcus, S.C. Examining the Relationship between Choice, Therapeutic Alliance and Outcomes in Mental Health Services. J. Pers. Med. 2013, 3, 191-202.

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J. Pers. Med. EISSN 2075-4426 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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