Understanding and Assessing the Therapeutic Relationship in Community Mental Health Care

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.