Longitudinal Association of Therapeutic Alliance and Clinical Outcomes in Supported Housing for Chronically Homeless Adults

General psychotherapy research has underscored the importance of the therapeutic alliance in client outcomes. This study examined
the association between therapeutic alliance and client outcomes specifically between chronically homeless clients in a supported
housing program and their case managers. Using data from a federal supported housing initiative, participants were categorized
into those who rated their therapeutic alliance with case managers at 3 months as relatively high (top 75th percentile; n = 123),
relatively low (bottom 25th percentile; n = 128), or did not identify any primary mental health provider at 3 months (n = 205).
Controlling for baseline differences, there were no group differences on any outcomes, except that participants who rated
high therapeutic alliance at 3 months reported the highest subjective quality of life and perceived social support. Client
outcomes in supported housing may rely more on practical assistance and access to other services than the quality of the therapeutic
relationship with their primary mental health provider.