Explaining engagement in outpatient therapy among adults with serious mental health conditions by degree of therapeutic alliance, therapist empathy, and perceived coercion

Psychiatr Rehabil J. 2022 Mar;45(1):79-88. doi: 10.1037/prj0000490. Epub 2021 Jun 17.


Objective: Adults with serious mental health conditions (SMHC) experience higher rates of disengagement from treatment. Factors associated with engagement in treatment in general for this population include therapeutic alliance, provider empathy, and perceived coercion. This cross-sectional exploratory study addressed the question: To what extent do client perceptions of therapeutic alliance, therapist empathy, and perceived coercion explain the degree of engagement in outpatient therapy for adults with SMHC? Method: An anonymous online survey measuring study variables was completed by 131 participants. The relationship between variables was tested using multivariate regression analysis with hierarchical blocks. Results: After separating therapeutic alliance and therapist empathy in the analysis due to multicollinearity and accounting for the influence of control variables, therapeutic alliance (B = .43, p < .01) and therapist empathy (B = .25, p < .01), but not perceived coercion, were associated with the degree of client engagement. Conclusions and Implications for Practice: For adults with SMHC enrolled in outpatient therapy, therapeutic alliance explained the greatest variation in the degree of engagement. Participants appeared to use outpatient therapy as a main strategy for pursuing recovery, and engagement in therapy may be increased if providers utilize strategies to strengthen expressions of empathy and bolster alliance. Additional research is needed to enhance understanding of engagement in therapy for this population and to develop more sensitive measures for evaluating these constructs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

MeSH terms

  • Adult
  • Coercion*
  • Cross-Sectional Studies
  • Empathy
  • Humans
  • Mental Disorders / therapy*
  • Mental Health
  • Outpatients
  • Patient Participation*
  • Professional-Patient Relations*
  • Therapeutic Alliance*