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WORKING ALLIANCE, HOPE, AND FUNCTIONAL OUTCOME FOR
INDIVIDUALS WITH SCHIZOPHRENIA: MECHANISMS OF INFLUENCE
by
Eri Nakagami
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIAL WORK)
May 2009
Copyright 2009 Eri Nakagami
Object Description
| Title | Working alliance, hope, and functional outcome for individuals with schizophrenia: mechanisms of influence |
| Author | Nakagami, Eri |
| Author email | nakagami@usc.edu; eri@nakagami.net |
| Degree | Doctor of Philosophy |
| Document type | Dissertation |
| Degree program | Social Work |
| School | School of Social Work |
| Date defended/completed | 2009-03-04 |
| Date submitted | 2009 |
| Restricted until | Restricted until 30 Apr. 2010. |
| Date published | 2010-04-30 |
| Advisor (committee chair) | Brekke, J. S. |
| Advisor (committee member) |
Palinkas, L. A. Neville-Jan, A. |
| Abstract | Despite progressive documentation of the effectiveness of community-based psychosocial rehabilitation programs, relatively little progress has been made during the past twenty years in delineating the treatment process variables related to successful psychosocial outcomes for persons with schizophrenia. Studies and narratives demonstrate that a strong working alliance is a prerequisite to treatment regardless of the type of therapy being provided. Moreover, the hope that individuals with schizophrenia derive through the consumer-provider relationship appears essential to achieving successful outcomes. Working alliance and hope are also highlighted as important elements in the current recovery and empowerment literature. Although often discussed singularly or in pairs, to date researchers have not examined the confluence of working alliance, hope, and psychosocial functioning with respect to persons with schizophrenia who are involved in community-based psychosocial rehabilitation programs.; This study examined the relationship and causal ordering between consumer working alliance, hope, and psychosocial functioning outcomes of individuals with schizophrenia participating in community-based psychosocial rehabilitation services. The study used a mixed methods sequential explanatory design which featured the consecutive collection and analysis of quantitative data and qualitative data, with the two methods combined during the final interpretation phase. The selection of sequential explanatory design for the study arose from the use of the qualitative results to enhance the exploration, explanation, and interpretation of the mainly quantitative investigation.; The study had five aims: 1) Investigate the empirical relationship between consumer working alliance, consumer hope, and consumer psychosocial functioning; 2) Evaluate if consumer hope mediates the relationship between consumer working alliance and psychosocial functioning; 3) Examine if the abovementioned mediation relationship is moderated by the study participants' length of attendance (less / more than three months); 4) Gain insight into issues and contexts related to consumers' working alliance, hope, and psychosocial functioning through qualitative semi-structured interviews; and 5) Explore and explain the quantitative results with the qualitative results to better understand the relationship and causal ordering between consumer working alliance, consumer hope, and consumer psychosocial functioning.; 100 individuals diagnosed with schizophrenia stratified by their length of attendance (less / more than three months) were randomly selected from a community-based psychosocial rehabilitation program. The ten participants for the qualitative study were purposefully sampled from the parent sample on the basis of race, gender, and ability to articulate their experiences.; Findings revealed a statistically significant association between working alliance and hope as well as among hope and psychosocial functioning. The second critical finding from this study was the statistically significant one-tailed mediation results that indicated a trend for hope to be the mechanism through which working alliance affects psychosocial functioning. This trend was substantiated in the qualitative phase as participants emphasized that the relationship between consumer working alliance and psychosocial functioning was driven by hope, which was influenced by spiritual and religious beliefs, encouragement from others, improvement of self-concept, and successful attainment of goals. The hypothesis that the mediation relationship from consumer working alliance to hope to psychosocial functioning may be moderated by length of attendance (less / more than three months) was not demonstrated. Implications from the study findings for clinical practice, policy resolutions, and future directions were also discussed. |
| Keyword | schizophrenia; working alliance; hope; functional outcome; treatment processes; mixed methods |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m2131 |
| Rights | Nakagami, Eri |
| Repository name | Libraries, University of Southern California |
| Repository address | Los Angeles, California |
| Repository email | http://www.usc.edu/isd/libraries/services/ask_a_librarian/email/ |
| Filename | etd-Nakagami-2760 |
| Archival file | uscthesesreloadpub_Volume26/etd-Nakagami-2760.pdf |
Description
| Title | Page 1 |
| Full text | WORKING ALLIANCE, HOPE, AND FUNCTIONAL OUTCOME FOR INDIVIDUALS WITH SCHIZOPHRENIA: MECHANISMS OF INFLUENCE by Eri Nakagami A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (SOCIAL WORK) May 2009 Copyright 2009 Eri Nakagami |
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