Assessment of diagnostic information and quality of working alliance with clients diagnosed with personality disorders during the mental health intake

Background: A primary purpose of diagnostic systems is to improve care, yet, little is known about how providers use it routine clinical care. Aims: We investigated specific DSM-IV personality disorders (PDs) diagnostic information therapists collected during intake visits and the association between a therapist PD diagnosis and clients’ and therapists’ reports of the quality of working alliance during the intake. Method: A total of 122 intakes (n = 34, 27.9% were diagnosed with PD) in four community mental health clinics in Israel were audiotaped. Immediately following the intake, clients and therapists completed the working alliance inventory (WAI). Independent clinicians coded the intakes using an information checklist. Results: Despite the relatively high prevalence of PD in regular psychiatric care, very limited PD diagnostic information was directly assessed during the intake. Therapists evaluated the quality of the working alliance when they saw a client they diagnosed with PD as significantly lower than the rating of a client without a PD, while the clients’ ratings did not differ as a result of their diagnosis. Conclusions: Therapists do not collect sufficient explicit diagnostic information to base their PD diagnostic decisions. Yet, the presence of PD diagnosis affects their rapport with their clients as early as the intake.