Explaining Engagement in Outpatient Therapy Among Adults With Serious Mental Health Conditions by Degree of Therapeutic Alliance, Therapist Empathy, and Perceived Coercion

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. Impact and Implications This study found that greater degrees of therapeutic alliance and therapist empathy were associated with enhanced engagement in outpatient therapy for adults with serious mental health conditions (SMHC). Providers may improve the degree of engagement in outpatient therapy for adults with SMHC by strengthening expressions of empathy and purposefully incorporating strategies to foster alliance. Given the reliance on outpatient therapy as a main strategy to pursue recovery for participants in this research, engagement in therapy is a paramount goal to support overall well-being and promote personal recovery.