Effective treatment relationships for persons with serious psychiatric disorders: The importance of attachment states of mind

Participants were 54 clients with serious psychiatric disorders and 21 clin ical case managers. Clients' serious psychiatric disorders included Axis I diagnoses, such as schizophrenia and bipolar disorder. This study examined how attachment states of mind of both clients and case managers influenced the effectiveness of therapeutic relationships and client functioning. Clie nt and case manager attachment states of mind interacted in predicting the working alliance and client functioning. Specifically, clients who were mor e deactivating with respect to attachment had better alliances and function ed better with less deactivating case managers, whereas clients who were le ss deactivating worked better with more deactivating case managers. These f indings highlight the importance of clinicians and clients being matched in ways that balance their interpersonal and emotional strategies.