The Impact of Provider Characteristics on the Quality of the Client-Provider Relationship in Mental Health Services

CHAIR: Beth Angell, Ph.D., Associate Professor

Client-provider relationship for outcomes in community-based services for persons with serious mental illness, little research attention has been given to the precursors of this relationship. This study represents an attempt to identify provider-related factors that influence the interpersonal context of service delivery and pays particular attention to providers’ patterns of thinking about challenging client behaviors. Specifically, it examines the impact of provider causal explanations, or attributions, for a common challenging client behavior, medication nonadherence, on the quality of the working relationship. Data were collected from 152 client-provider dyads from a large, urban community mental health clinic. Focal independent variables capturing aspects of providers’ attributions for client medication nonadherence were derived from providers’ written responses to a question eliciting reasons why clients may not take medications as prescribed. Using both a novel approach and a modified version of an established method of coding attributions, provider responses were rated to measure multiple dimensions of their attributional patterns. Bivariate, OLS regression, and HLM analytic strategies were used to examine the impact of these provider attribution patterns on the quality of the client-provider relationship.

Although there is a growing evidence base that supports the importance of the results indicated that client experience of the negative relationship was impacted by both the complexity and content of providers’ attributions. Specifically, clients perceived less criticism and rejection when their providers generated a greater number of explanations for client medication nonadherence and when those explanations included mention of client beliefs about their illness and medication. Provider perception of the negative relationship was impacted by the dimensionality of provider attributions. That is, providers who generated causal explanations external to the client perceived less conflict and demoralization in their relationships with clients. Finally, provider perceptions of the positive relationship were impacted again by the content of their attributions. In this case, providers who acknowledged pragmatic impediments as possible causes of medication nonadherence perceived greater levels of satisfaction and connection in their relationships with clients. Together, these finding offer several implications for practice and future research. Most fundamentally, they suggest that training and supervision efforts targeting providers’ thinking patterns may result in improving the quality of the interpersonal context in which services are delivered. Providers should be encouraged to think in more differentiated ways about why clients may engage in challenging behaviors and should be prompted to examine clients’ environments for possible causal sources, paying particular attention to pragmatic and concrete realities in clients’ lives. Furthermore, client beliefs about medication and mental illness should be acknowledged as providers reason about their potentially challenging behaviors. In addition to replicating the current findings, future studies should also examine the pathways by which provider causal explanations exert their influence on the quality of the helping relationship.

About the Author

COLLEEN A. MAHONEY is currently an Assistant Professor at the School of Social Work, University of Wisconsin-Madison. Her research and teaching interests include serious mental illness, co-occurring disorders, mental health service delivery, and intensive community-based services such as Assertive Community Treatment, with a particular focus on the interpersonal context of these services.