| dc.description.abstract | The clinician-patient relationship is at the core of community mental health care
and impacts on outcome, but no instrument has been specifically developed for
its assessmentE. xisting scalesh ave either unproven psychometric properties in
community mental health care settings, or have been designed for other
therapeutic settings, or both. My aim in this thesis is to develop a scale to assess
the therapeutic relationship in community mental health care (STAR) that has
both clinician and patient versions. In part one, understanding the therapeutic
relationship in community care, I considered the rationale for mental health care
in the community and explore theoretical presuppositions, pre-existing measures,
and influences on the therapeutic relationship. In part two, assessing the
therapeutic relationship in community care, I developed an assessment tool in
four stages. In stage one I generated an item pool using semi-structured
interviews and existing scales. In stage two I administered this item pool to 133
community care patients and their 26 clinicians. I constructed subscales based on
principal components analyses. In stage three, for final item selection, I assessed
retest-reliability. In stage four the scales were administered to a new sample of
180 patients and their 84 clinicians. The factorial structure of the scale was
confirmed with a good fit. The end result is both a patient and clinician version
of STAR which has 12 items comprising 3 subscales: positive collaboration (6
items) and positive clinician input (3 items) in both versions, non-supportive
clinician input in the patient version and emotional difficulties in the clinician
version (3 items each). Psychometric properties are satisfactory. STAR is a
specifically developed, brief scale to assess therapeutic relationships in
community care. The two versions cover three similar factors each, and may be
used in research and routine care. | en_US |
