Effects of Client Perceptions of Therapeutic Alliance, Empowerment, Attitudes Toward Medication and Insight on Functioning

Background: Limited research is available on how Assertive Community Treatment (ACT) clients’ cognitions, attitudes and behaviours experienced over time during the therapeutic process and recovery, affect functioning.Aims: This prospective study investigated whether changes in 1) clients’ ratings of therapeutic alliance, sense of empowerment over their illness, attitudes toward medication and insight, 2) clinicians’ assessment of medication adherence and 3) delivered services predicted functioning of ACT clients in southern Ontario, Canada.Method: Hierarchical Linear Modelling was used to assess time-varying and invariant predictors of overall functioning, over a two-year follow-up period.Results: The study found that during each 6 month follow-up time period about 90% of clients achieved successful community tenure and overall functioning increased between baseline and year 1 and decreased between baseline and year 2. Clients’ ratings of therapeutic alliance on functioning were moderated by previous lifetime days in hospital, while change in ratings of empowerment was moderated by age and previous lifetime days in hospital. Improved insight and medication adherence predicted functioning. Number of client contacts by ACT staff was not associated with functioning.Conclusions: These findings suggest that changes in client’s cognitions, attitudes and behaviours experienced during the therapeutic process and recovery can predict client functioning