Date of Submission


Degree Type


Degree Name

Doctor of Psychology (PsyD)



Department Chair

Robert A DiTomasso, PhD, ABPP, Chair, Department of Psychology

First Advisor

Petra Kottsieper, PhD, Chairperson

Second Advisor

Bruce Zahn, EdD, ABPP

Third Advisor

Mark Salzer, PhD


It is likely that the success of treatment techniques in increasing consumers’ sense of inclusion in treatment decision making and increasing the likelihood for improved treatment outcomes for individuals with severe and persistent mental illness depends on the presence of common trait variables, such as empowerment and treatment-specific efficacy and process variables, such as the therapeutic relationship and the use of a shared decision-making style. To understand the relationships between these variables in individuals with serious mental illness (SMI), this study used an archival data set consisting of 396 adults with major depression and schizophrenia-spectrum disorders from Philadelphia area community mental-health centers. Questions covered their experience of global empowerment, the amount of confidence they had in asking questions of their physicians, their sense of shared decision making, the quality of the alliance with their treatment providers, and their perceived treatment
satisfaction/outcomes. Hierarchical regression and multiple linear regression analyses were conducted to determine the relationship between the variables using the Empowerment Scale (ES), Working Alliance Inventory (WAI), Perceived Efficacy in Patient-Physician Interactions (PEPPI), Participatory Decision-Making Scale (PDMS), and their contribution to perceived treatment outcomes in individuals with serious mental illness, measured by the Mental Health Statistical Improvement Program Inventory (MHSIP). Participants articulated greater treatment satisfaction outcomes in the presence of greater perceived global empowerment, greater perceived inclusion in treatment decision making, and greater perceived working alliance. Participants also articulated greater sense of shared decision making in the presence of greater empowerment and
working alliance. Treatment outcomes and sense of inclusion in decision making were not significantly related to sense of treatment specific efficacy. The results of this study indicate the need for greater understanding of how to increase the sense of empowerment of individuals with SMI, as well as the need for clinicians to develop greater skill at fostering a sense of inclusion and working alliance in treatment to ensure greater treatment outcome satisfaction.

Included in

Psychology Commons