Staff and patient perspectives on unmet need and therapeutic alliance in community mental health services

Background Therapeutic alliance between clinicians and their patients is important in community mental healthcare. It is unclear whether providing effective interventions influences therapeutic alliance. Aims To assess the impact of meeting previously unmet mental health needs on the therapeutic alliance between patients and clinicians. Method Secondary analysis of data from a longitudinal study assessing 101 patients and paired staff Results Patient-rated unmet need was negatively associated with patient-rated and staff-rated therapeutic alliance. Staff-rated unmet need was positively associated with patient-rated therapeutic alliance only. Reducing patient-rated unmet need increased patient-rated but not staff-rated therapeutic alliance, even when controlling for other variables. Reducing staff-rated unmet need increased staff-rated but not patient-rated therapeutic alliance, but the effect became insignificant when controlling for other variables. Conclusions Patient-rated therapeutic alliance will be maximised by focusing assessment and interventions on patient-rated rather than staff-rated unmet need.