The therapeutic working alliance (TA) between clinicians and their patients is considered an important factor as to the course and outcome of any therapy aiming to improve mental problems. Psychotherapy research has focused mainly on the individual personal relationship between patient and therapist as a source of this working alliance. Factors other therapist skills that determine the building up of the TA are sparsely investigated in particular in community mental health settings.

Data from a randomized controlled study (ISRCTN16971059) aiming at the improvement of outcome in community treatment by providing therapists with clues to the individual needs of their patients were used to assess determinants of the TA within this framework

The evolvement of the TA in the work with severe and persistent mentally ill people appears to be a dynamic process that is essentially driven by the individual patients service needs. As to individual outcomes the ability to repair ruptures in this working alliance seems to be more important than keeping TA high during the course of therapy.