The climate and culture of treatment for clients with serious mental illness (SMI) are complex. In this study, we aim to cultivate a deeper understanding of the treatment environment using a network typological approach to measure the local treatment context and assess its implications on the perceived quality of clients’ relationships with their care providers. We use in-depth egocentric network data from clients with SMI in community mental health centers and state psychiatric hospitals from the Indiana Mental Health Services and HIV Risk Study (N = 417). Clustering analysis identifies five unique and distinct network types: supportive, sparse, diverse, clinical, and treatment-focused. Weighted least squares regressions reveal clients in networks with high amounts of support predict a more trusting working alliance, whereas care-oriented networks predict a less trusting alliance. Our findings underscore the need to consider the local network context in studies of the quality of care provided to people with SMI.
AckermanSteven J.HilsenrothMark J.2001. “A Review of Therapist Characteristics and Techniques Negatively Impacting the Therapeutic Alliance.” Psychotherapy: Theory, Research, Practice, Training38:171–85.
2.
AlangSirry M.McAlpineDonna D.2019. “Pathways to Mental Health Services and Perceptions about the Effectiveness of Treatment.” Society and Mental Health9:388–407.
3.
AneshenselCarol S.2013. “Mental Illness as a Career: Sociological Perspectives.” Pp. 603–20 in Handbook of the Sociology of Mental Health. Handbooks of Sociology and Social Research, edited by AneshenselC. S.PhelanJ. C.BiermanA.Dordrecht, The Netherlands: Springer.
4.
ArditoRita B.RabellinoDaniela. 2011. “Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research.” Frontiers in Psychology2:270.
5.
BlackSusannaHardyGillianTurpinGrahamParryGlenys. 2005. “Self-reported Attachment Styles and Therapeutic Orientation of Therapists and Their Relationship with Reported General Alliance Quality and Problems in Therapy.” Psychology and Psychotherapy: Theory, Research and Practice78:363–77.
6.
BordinEdward S.1979. “The Generalizability of the Psychoanalytic Concept of the Working Alliance.” Psychotherapy: Theory, Research & Practice16:252–60.
7.
ChronisterJulieChouChih-ChinFitzgeraldSandraLiaoHsin-Ya. 2016. “Social Support and Persons with Psychiatric Disabilities: A Cluster Analysis.” Journal of Applied Rehabilitation Counseling47:29–40.
8.
ChuaVincentMadejJuliaWellmanBarry. 2011. “Personal Communities: The World According to Me.” Pp. 101–15 in The SAGE Handbook of Social Network Analysis, edited by ScottJohnCarringtonPeter J.Thousand Oaks, CA: Sage.
9.
CrossleyNickBellottiElisaEdwardsGemmaEverettMartin G.KoskinenJohanTranmerMark. 2015. Social Network Analysis for Ego-nets. London, England: Sage.
10.
DavidsonLarryShaharGolanStaynerDavid A.ChinmanMatthew J.RakfeldtJaakTebesJacob Kraemer. 2004. “Supported Socialization for People with Psychiatric Disabilities: Lessons from a Randomized Controlled Trial.” Journal of Community Psychology32:453–77.
11.
DobranskyKerry Michael. 2014. Managing Madness in the Community: The Challenge of Contemporary Mental Health Care. New Brunswick, NJ: Rutgers University Press.
12.
DobranskyKerry Michael. 2019. “Breaking Down Walls, Building Bridges: Professional Stigma Management in Mental Health Care.” Society and Mental Health9:228–42.
13.
FioriKatherine L.AntonucciToni C.CortinaKai S.2006. “Social Network Typologies and Mental Health among Older Adults.” The Journals of Gerontology: Series B61:25–32.
14.
FioriKatherine L.SmithJacquiAntonucciToni C.2007. “Social Network Types Among Older Adults: A Multidimensional Approach.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences62:P322–30.
15.
GillJeffTorresMichelle. 2019. Generalized Linear Models: A Unified Approach. Thousand Oaks, CA: Sage.
16.
GlissonCharlesLandsverkJohnSchoenwaldSonjaKelleherKellyHoagwoodKimberly EatonMaybergStephenGreenPhilipand Research Network on Youth Mental Health. 2008. “Assessing the Organizational Social Context (OSC) of Mental Health Services: Implications for Research and Practice.”Administration and Policy in Mental Health35:98–113.
17.
HairJoseph F.AndersonRolph E.TathamRonald L.BlackWilliam C.1984. Multivariate Data Analysis with Readings, 1995. Tulsa, OK: Petroleum.
18.
HorvathAdam O.Del ReA. C.FlückigerChristophSymondsDianne. 2011. “Alliance in Individual Psychotherapy.” Psychotherapy48:9–16.
19.
HorvathAdam O.SymondsDianne D.1991. “Relation between Working Alliance and Outcome in Psychotherapy: A Meta-analysis.” Journal of Counseling Psychology38:139–49.
20.
JonesSteven H.ThornicroftGrahamCoffeyMichaelDunnGraham. 1995. “A Brief Mental Health Outcome Scale: Reliability and Validity of the Global Assessment of Functioning (GAF).” The British Journal of Psychiatry166:654–59.
21.
KarpDavid Allen. 2006. Is It Me or My Meds? Living with Antidepressants. Cambridge, MA: Harvard University Press.
22.
KassambaraAlboukadel. 2017. Practical Guide to Cluster Analysis in R: Unsupervised Machine Learning. Vol. 1. Statistical Tools for High-throughput Data Analysis. STHDA.
23.
LiTingZhangYanlong. 2015. “Social Network Types and the Health of Older Adults: Exploring Reciprocal Associations.” Social Science & Medicine130:59–68.
24.
LitwinHowardShiovitz-EzraSharon. 2011. “Social Network Type and Subjective Well-being in a National Sample of Older Americans.” The Gerontologist51:379–88.
25.
MallinckrodtBrentNelsonMary Lee. 1991. “Counselor Training Level and the Formation of the Psychotherapeutic Working Alliance.” Journal of Counseling Psychology38:133–38.
26.
MarsdenPeter V.1987. “Core Discussion Networks of Americans.” American Sociological Review52:122–31.
27.
MartinDaniel J.GarskeJohn P.DavisM. Katherine. 2000. “Relation of the Therapeutic Alliance with Outcome and Other Variables: A Meta-analytic Review.” Journal of Consulting and Clinical Psychology68:438–50.
28.
McCartyChristopherLubbersMiranda J.VaccaRaffaeleMolinaJosé Luis. 2019. Conducting Personal Network Research: A Practical Guide. New York: Guilford Publications.
29.
McConnellWill R.PerryBrea L.2016. “The Revolving Door: Patient Needs and Network Turnover during Mental Health Treatment.” Pp. 119–45 in 50 Years after Deinstitutionalization: Mental Illness in Contemporary Communities. Vol. 17: Advances in Medical Sociology, edited by PerryB. L.Bingley, England: Emerald Group.
30.
MeeksSuzanneMurrellStanley A.1994. “Service Providers in the Social Networks of Clients with Severe Mental Illness.” Schizophrenia Bulletin20:399–406.
31.
PerryBrea L.FriehEmmaWrightEric R.2018. “Therapeutic Social Control of People with Serious Mental Illness: An Empirical Verification and Extension of Theory.” Society and Mental Health8:108–22.
32.
PerryBrea L.PescosolidoBernice A.2010. “Functional Specificity in Discussion Networks: The Influence of General and Problem-specific Networks on Health Outcomes.” Social Networks32:345–57.
33.
PerryBrea L.PescosolidoBernice A.2015. “Social Network Activation: The Role of Health Discussion Partners in Recovery from Mental Illness.” Social Science & Medicine125:116–28.
34.
PerryBrea L.PescosolidoBernice A.BorgattiStephen P.2018. Egocentric Network Analysis: Foundations, Methods, and Models. Cambridge, England: Cambridge University Press.
35.
PescosolidoBernice A.2006. “Of Pride and Prejudice: The Role of Sociology and Social Networks in Integrating the Health Sciences.” Journal of Health and Social Behavior47:189–208.
36.
PescosolidoBernice A.BoyerCarol A.1999. “How Do People Come to Use Mental Health Services? Current Knowledge and Changing Perspectives.” Pp. 392–411 in A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems, edited by HorwitzA. V.ScheidT. L.New York: Cambridge University Press.
37.
PescosolidoBernice A.RubinBeth A.2000. “The Web of Group Affiliations Revisited: Social Life, Postmodernism, and Sociology.” American Sociological Review65:52–76.
38.
R Core Team. [2013] 2019. R: A Language and Environment for Statistical Computing, Version 3.0. 2. Vienna, Austria: R Foundation for Statistical Computing.
39.
SantiniZiggiKoyanagiIvan, AiTyrovolasStefanosHaroJosep M.FioriKatherine L.UwakwaRichardThiyagarajanJotheeswaran A.WebberMartinPrinceMartinPrinaA. Matthew. 2015. “Social Network Typologies and Mortality Risk among Older People in China, India, and Latin America: A 10/66 Dementia Research Group Population-based Cohort Study.” Social Science & Medicine147:134–43.
40.
SchaferMarkus H.2013. “Discussion Networks, Physician Visits, and Non-conventional Medicine: Probing the Relational Correlates of Health Care Utilization.” Social Science & Medicine87:176–84.
41.
ScheidTeresa L.2004. Tie a Knot and Hang on: Providing Mental Health Care in a Turbulent Environment. Hawthorne, New York: Aldine de Gruyter.
42.
ScheidTeresa L.2010. “Consequences of Managed Care for Mental Health Providers.” Pp. 529–547 in A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems (2nd ed.), edited by ScheidT.L.BrownT.N.New York: Cambridge University Press.
43.
ScottJohn. 2017. Social Network Analysis. Thousand Oaks, CA: Sage.
44.
SimmelGeorg. 1955. Conflict and the Web of Group Affiliations. Translated by WolffKurt H.BendixReinhard. New York: Free Press.
45.
StoneLeroyRosenthalCarolyn . 1996. “Profiles of the Social Networks of Canada’s Elderly: An Analysis of 1990 General Social Survey Data.” The Social Networks of Older People: A Cross-National Analysis 77–97.
46.
ThoitsPeggy A.2011. “Perceived Social Support and the Voluntary, Mixed, or Pressured Use of Mental Health Services.” Society and Mental Health1:4–19.
47.
TraceyTerence J.KokotovicAnna M.1989. “Factor Structure of the Working Alliance Inventory.” Psychological Assessment1:207–10.
48.
VogelDavid L.WadeNathaniel G.WesterStephen R.LarsonLisaHacklerAshley H.2007. “Seeking Help from a Mental Health Professional: The Influence of One’s Social Network.” Journal of Clinical Psychology63:233–45.
49.
WalshJosephConnellyPatrick R.1996. “Supportive Behaviors in Natural Support Networks of People with Serious Mental Illness.” Health & Social Work21:296–303.
50.
WellmanBarryPotterStephanie. 1999. “The Elements of Personal Communities.” Pp. 49–81 in Networks in the Global Village: Life in Contemporary Communities, edited by WellmanBarry. Boulder, CO: Westview Press.
51.
WrightEric R.1999. “HIV Risk of Mental Illness Clients across Service Sites.” Unpublished Grant Proposal (NIMH R01 MH 59717). Indiana University–Purdue University, Indianapolis, IN.
52.
WrightEric R.2001. “The Sexual Culture of Psychiatric Treatment Facilities and Mental Illness Clients’ HIV Risk: A Theoretical Framework and Pilot Study.” Pp. 275–309 in The Organizational Response to Social Problems. Vol. 8: Research in Social Problems and Public Policy, edited by HartwellS. W.SchuttR. K.Bingley, England: Emerald Group.
53.
WrightEric R.GaymanMathew. 2005. “Sexual Networks and HIV Risk of People with Severe Mental Illness in Institutional and Community-based Care.” AIDS and Behavior9:341–53.
54.
WrightEric R.MartinT. N.2003. “The Social Organization of HIV/AIDS Care in Treatment Programmes for Adults with Serious Mental Illness.” AIDS Care15:763–74.
