Content and implementation of clinical decisions in the routine care of people with severe mental illness

Jana Konrad, Sabine Loos, Petra Neumann, Nadja Zentner, Benjamin Mayer, Mike Slade, Harriet Jordan, Corrado De Rosa, Valeria Del Vecchio, Aniko Egerhazi, Marietta Nagy, Malene Krogsgaard Bording, Helle Østermark Sørensen, Wolfram Kawohl, Wulf Rössler, Bernd Puschner, The CEDAR study group

Research output: Contribution to journalJournal articleResearchpeer-review

6 Citations (Scopus)


PURPOSE: 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.

Original languageEnglish
JournalJournal of Mental Health
Issue number1
Pages (from-to)15-19
Number of pages5
Publication statusPublished - 2015


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