Does therapeutic alliance exist in team-based hospital settings? A qualitative study in complex continuing care
Bibliographic record
Abstract
Therapeutic Alliance is a measurable construct reflecting patient-provider relationships. It is known to predict important healthcare outcomes in both the mental health and general medical contexts. However, it has not been validated in team-based healthcare settings, such as hospitals. Complex Continuing Care (CCC) is a chronic-care hospital setting that manages patients with significant multi-morbidity and extensive nursing care needs, beyond the capacity of long-term care. The combination of long lengths of stay and very large health-care teams make CCC an environment where patient-provider relationships are a prominent part of the healthcare experience. We sought therefore to explore therapeutic relationships in CCC, using a qualitative approach to determine whether patients experience team-based care as a collection of individual therapeutic relationships, for which alliance could be measured, or conversely whether they experience team-based care as a diffuse, team-based relationship to which individual therapeutic alliances as currently understood do not apply. To do so, we interviewed 16 CCC patients using a semi-structured format. Interviews were transcribed and analyzed via qualitative analysis. This analysis revealed that the predominant emphasis was upon 1:1 relationships with healthcare providers as most determinant of care experience, with little emphasis on diffuse or team-based relationships. This study shows that in a setting of high clinical complexity, despite care being delivered by a large team of multiple disciplines, the centrality of 1:1 relationships between patients and their clinicians was paramount, providing the first-ever qualitative evidence for the validity of therapeutic alliance in the team-based setting.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".