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At the intersection of lay and professional social networks: how community ties shape perceptions of mental health treatment providers

  • B. L. Perry (a1) (a2), E. Pullen (a2) and B. A. Pescosolido (a1) (a2)

The therapeutic alliance is a critical determinant of individuals’ persistence and outcomes in mental health treatment. Simultaneously, individuals’ community networks shape decisions about whether, when, and what kind of treatment are used. Despite the similar focus on social relationship influence for individuals with serious mental illness, each line of research has maintained an almost exclusive focus on either ‘inside’ (i.e. treatment) networks or ‘outside’ (i.e. community) networks, respectively.


For this study, we integrate these important insights by employing a network-embedded approach to understand the therapeutic alliance. Using data from the Indianapolis Network Mental Health Study (INMHS, n = 169, obs = 2206), we target patients experiencing their first major contact with the mental health treatment system. We compare patients’ perceptions of support resources available through treatment providers and lay people, and ask whether evaluations of interpersonal dimensions of the therapeutic alliance are contingent on characteristics of community networks.


Analyses reveal that providers make up only 9% of the whole social network, but are generally perceived positively. However, when community networks are characterized by close relationships and frequent contact, patients are significantly more likely to report that treatment providers offer useful advice and information. Conversely, when community networks are in conflict, perceptions of treatment providers are more negative.


Community-based social networks are critical for understanding facilitators of and barriers to effective networks inside treatment, including the therapeutic alliance. Implications for community-based systems of care are discussed in the context of the USA and global patterns of deinstitutionalization and community reintegration.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Address for correspondence: B. Perry, Ph.D., Department of Sociology, Indiana University, Ballantine Hall 744, Bloomington, IN 47405, USA. (Email:
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Abbott, KM, Bettger, JP, Hanlon, A, Hirschman, KB (2012). Factors associated with health discussion network size and composition among elderly recipients of long-term services and supports. Health Communication 27, 784793.
Aberg-Wistedt, A, Cressell, T, Lidberg, Y, Liljenberg, B, Osby, U (1995). Two-year outcome of team-based intensive care management for patients with schizophrenia. Psychiatric Services 46, 12631266.
Abramowitz, MZ, Grinshpoon, A, Priebe, S, Ponizovsky, AM (2008). New institutionalization as a rebound phenomenon? The case of Israel. Israel Journal of Psychiatry and Related Sciences 45, 272.
Ackerman, SJ, Hilsenroth, MJ (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review 23, 133.
Adair, CE, McDougall, GM, Mitton, CR, Joyce, AS, Wild, C, Gordon, A, Beckie, A (2005). Continuity of care and health outcomes among persons with severe mental illness. Psychiatric Services 56, 10611069.
Adams, JR, Drake, RE, Wolford, GL (2007). Shared decision-making preferences of people with severe mental illness. Psychiatric Services 58, 12191221.
Ajrouch, KJ, Antonucci, TC, Janevic, MR (2001). Social networks among blacks and whites: the interaction between race and age. Journal of Gerontology B, Psychological Social Science 56, S112S118.
Álvarez-Jiménez, M, Gleeson, JF, Bendall, S, Lederman, R, Wadley, G, Killackey, E, McGorry, PD (2012). Internet-based interventions for psychosis: a sneak-peek into the future. Psychiatric Clinics of North America 35, 735747.
Anthony, WA, Blanch, A (1989). Research on community support services: what have we learned? Psychosocial Rehabilitation Journal 12, 55.
Barrowclough, C, Meier, P, Beardmore, R, Emsley, R (2010). Predicting therapeutic alliance in clients with psychosis and substance misuse. Journal of Nervous & Mental Disease 198, 373377.
Becker, T, Thornicroft, G, Leese, M, McCrone, P, Johnson, S, Albert, M, Turner, D (1997). Social networks and service use among representative cases of psychosis in South London. British Journal of Psychiatry 171, 1519.
Becker, T, Vázquez-Barquero, JL (2001). The European perspective of psychiatric reform. Acta Psychiatrica Scandinavica 104(s410), 814.
Biegel, DE, Schulz, R (1999). Caregiving and caregiver interventions in aging and mental illness. Family Relations 48, 345.
Bolger, N, Zuckerman, A, Kessler, RC (2000). Invisible support and adjustment to stress. Journal of Personality and Social Psychology 79, 953961.
Browne, K, Roseman, D, Shaller, D, Edgman-Levitan, S (2010). Analysis and commentary measuring patient experience as a strategy for improving primary care. Health Affairs 29, 921925.
Carpentier, N, Bernard, P (2011). The complexities of help-seeking: Exploring challenges through a social network perspective. In Handbook of the Sociology of Health, Illness, and Healing (ed. Pescosolido, B. A., Martin, J. K., McLeod, J. D. and Rogers, A.), pp. 465479. Springer: New York.
Chien, WT, Norman, I (2003). Educational needs of families caring for Chinese patients with schizophrenia. Journal of Advanced Nursing 44, 490498.
Chou, KL, Liang, K, Sareen, J (2011). The association between social isolation and DSM-IV mood, anxiety, and substance use disorders: wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry 72, 14681476.
Cohen, AN, Drapalski, AL, Glynn, SM, Medoff, D, Fang, LJ, Dixon, LB (2013). Preferences for family involvement in care among consumers with serious mental illness. Psychiatric Services 64, 257263.
Cooper, LA, Powe, NR (2004). Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance. The Commonwealth Fund. July 2004.
Cruz, M, Pincus, HA (2002). Research on the influence that communication in psychiatric encounters has on treatment. Psychiatric Services 53, 12531265.
Curtis, LC, Wells, SM, Penney, DJ, Ghose, SS, Mistler, LA, Mahone, IH, Lesko, S (2010). Pushing the envelope: shared decision making in mental health. Psychiatric Rehabilitation Journal 34, 1422.
Drake, RE, Deegan, PE, Rapp, C (2010). The promise of shared decision making in mental health. Psychiatric Rehabilitation Journal 34, 713.
Elvins, R, Green, J (2008). The conceptualization and measurement of therapeutic alliance: an empirical review. Clinical Psychology Review 28, 11671187.
Faccincani, C, Mignolli, G, Platt, S (1990). Service utilisation, social support, and psychiatric status in a cohort of patients with schizophrenic psychoses: a 7 year follow-up study. Schizophrenia Research 3, 139146.
Fakhoury, W, Priebe, S (2002). The process of deinstitutionalization: an international overview. Current Opinion in Psychiatry 15, 187192.
Fallowfield, LJ (2008). Treatment decision-making in breast cancer: the patient-doctor relationship. Breast Cancer Research and Treatment 112, 513.
Fleury, MJ, Grenier, G, Caron, J, Lesage, A (2008). Patients’ report of help provided by relatives and services to meet their needs. Community Mental Health Journal 44, 271281.
Givens, JL, Houston, TK, Van Voorhees, BW, Ford, DE, Cooper, LA (2007). Ethnicity and preferences for depression treatment. General Hospital Psychiatry 29, 182191.
Green, J (2006). Annotation: the therapeutic alliance – a significant but neglected variable in child mental health treatment studies. Journal of Child Psychology and Psychiatry 47, 425435.
Hilsenroth, MJ, Cromer, TD, Ackerman, SJ (2012). How to make practical use of therapeutic Alliance Research in your clinical work. In Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (ed. Levy, R. A., Ablon, J. S. and Kächele, H.), pp. 361380. Humana Press (Springer): New York, NY.
Horvath, AO (2001). The alliance. Psychotherapy: Theory, Research, Practice, Training 38, 365372.
Horwitz, AV (1977). Social networks and pathways into psychiatric treatment. Social Forces 56, 86105.
Johansson, H, Eklund, M (2006). Helping alliance and early dropout from psychiatric out-patient care: the influence of patient factors. Social Psychiatry and Psychiatric Epidemiology 41, 140147.
Kadushin, C (1966). The friends and supporters of psychotherapy: on social circles in urban life. American Sociological Review 31, 786.
Kreyenbuhl, J, Nossel, IR, Dixon, LB (2009). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophrenia Bulletin 35, 696703.
Laugharne, R, Priebe, S (2006). Trust, choice, and power in mental health: a literature review. Psychiatry and Psychiatric Epidemiology 41, 846852.
Lipton, FR, Cohen, CI, Fischer, EH, Katz, SE (1981). Schizophrenia: a network crisis. Schizophrenia Bulletin 7, 144151.
Lo, M-C, Stacey, CL (2008). Beyond cultural competency: Bourdiea, patients, and clinical encounters. Sociology of Health & Illness 30, 741755.
Lucksted, A, McFarlane, W, Downing, D, Dixon, L (2012). Recent developments in family psychoeducation as an evidence-based practice. Journal of Marital and Family Therapy 38, 101121.
Marsden, P (1987). Core discussion networks of Americans. American Sociological Review 52, 122131.
McCabe, R, Priebe, S (2004). The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. International Journal of Social Psychiatry 50, 115128.
Neale, MS, Rosenheck, RA (1995). Therapeutic alliance and outcome in a VA intensive case management program. Psychiatric Services 46, 719721.
Ostrom, E (2009). A general framework for analyzing sustainability of social-ecological systems. Science 325, 419422.
Pachucki, MA, Breiger, RL (2010). Cultural holes: beyond relationality in social networks and culture. Annual Review of Sociology 36, 205224.
Peek, MK, O'Neill, GS (2001). Networks in later life: an examination of race differences in social support networks. International Journal of Aging and Human Development 52, 197219.
Perry, BL, Pescosolido, BA (2010). Functional specificity in discussion networks: the influence of general and problem-specific networks on health outcomes. Social Networks 32, 345357.
Perry, BL, Pescosolido, BA (2012). Social network dynamics and biographical disruption: the case of “first-timers” with mental illness. American Journal of Sociology 118, 134175.
Perry, B, Pescosolido, B (2015). Social network activation: the role of health discussion partners in recovery from mental illness. Social Science & Medicine 125, 116128.
Pescosolido, B (1991). Illness careers and network ties: a conceptual model of utilization and compliance. In Advances in Medical Sociology (ed. Albrecht, G. and Levy, J.), pp. 161184. JAI Press: Greenwich, CN.
Pescosolido, B (1992). Beyond rational choice: the social dynamics of how people seek help. American Journal of Sociology 97, 10961138.
Pescosolido, B (2006). Of pride and prejudice: the role of sociology and social networks in integrating the health sciences. Journal of Health and Social Behavior 47, 189208.
Pescosolido, B, Boyer, CA (2010). Understanding the context and dynamic social processes of mental health treatment. In A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems, 2nd edn (ed. Hortwitz, A. V. and Scheid, T. L.), pp. 420438. Cambridge University Press: New York, NY.
Pescosolido, B, Gardner, CB, Lubell, KM (1998 a). How people get into mental health services: stories of choice, coercion, and “muddling through” from “first-timers”. Social Science & Medicine 46, 275286.
Pescosolido, B, Wright, ER, Alegría, M, Vera, M (1998 b). Social networks and patterns of use among the poor with mental health problems in Puerto Rico. Medical Care 36, 10571072.
Pitschel-Walz, G, Leucht, S, Bäuml, J, Kissling, W, Engel, RR (2001). The effect of family interventions on relapse and rehospitalization in schizophrenia: a meta-analysis. Schizophrenia Bulletin 27, 7392.
Priebe, S, Frottier, P, Gaddini, A, Kilian, R, Lauber, C, Martínez-Leal, R, Wright, D (2008). Mental health care institutions in nine European countries, 2002 to 2006. Psychiatric Services 59, 570573.
Rafaeli, E, Gleason, MEJ (2009). Skilled support within intimate relationships. Journal of Family Theory and Review 1, 2037.
Roe, D, Goldblatt, H, Baloush-Klienman, V, Swarbrick, M, Davidson, L (2009). Why and how people decide to stop taking prescribed psychiatric medication: exploring the subjective process of choice. Psychiatric Rehabilitation Journal 33, 3846.
Rogers, A (1993). Coercion and ‘voluntary’ admission: an examination of psychiatric patient views. Behavioral Sciences & The Law 11, 259267.
Rogers, CR (1951). Client-Centered Therapy. Riverside Press: Cambridge, MA.
Rosen, A (2006). The Australian experience of deinstitutionalization: interaction of Australian culture with the development and reform of its mental health services. Acta Psychiatrica Scandinavica 113(s429), 8189.
Rosenberg, M (1965). Society and the Adolescent Self-Image. Princeton University Press: Princeton, NJ.
Sajatovic, M, Davies, M, Hrouda, DR (2004). Enhancement of treatment adherence among patients with bipolar disorder. Psychiatric Services 55, 264269.
Salvio, M-A, Beutler, L, Wood, J, Engle, D (1992). The strength of the therapeutic alliance in three treatment for depression. Psychotherapy Research 2, 3136.
Schafer, MH (2013). Discussion networks, physician visits, and non-conventional medicine: probing the relational correlates of health care utilization. Social Science and Medicine 87, 176184.
Sealy, P, Whitehead, PC (2004). Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment. Canadian Journal of Psychiatry 49, 249257.
Seaman, S, Pavlou, M, Copas, A (2014). Review of methods for handling confounding by cluster and informative cluster size in clustered data. Statistics in Medicine 33, 53715387.
Spitzer, RL, Williams, JBW, Gibbon, M, First, MB (1990). Structured Clinical Interview for DSM-III-R. American Psychiatric Press: Washington, DC.
Stroul, BA (1989). Community support systems for persons with long-term mental illness: a conceptual framework. Psychosocial Rehabilitation Journal 12, 9.
Tanner, JL, Stein, MT, Olson, LM, Frintner, MP, Radecki, L (2009). Reflections on well-child care practice: a national study of pediatric clinicians. Pediatrics 124, 849–587.
Tarrier, N, Barrowclough, C, Vaughn, C, Bamrah, JS, Porceddu, K, Watts, S, Freeman, H (1989). Community management of schizophrenia. A two-year follow-up of a behavioural intervention with families. The British Journal of Psychiatry 154, 625628.
Thoits, P (2011). Perceived social support and the voluntary, mixed, or pressured use of mental health services. Society and Mental Health 1, 419.
Truog, RD (2012). Patients and doctors: the evolution of a relationship. New England Journal of Medicine 366, 581585.
Velligan, DI, Weiden, PJ, Sajatovic, M, Scott, J, Carpenter, D, Ross, R, Docherty, JP (2010). Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines. Journal of Psychiatric Practice 16, 306324.
Zlotnick, C, Elkin, I, Shea, MT (1998). Does the gender of a patient or the gender of a therapist affect the treatment of patients with major depression? Journal of Consulting and Clinical Psychology 66, 655659.
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