Working alliance, daily activities, and emotions in patients with schizophrenia spectrum disorders and treating staff: a study with the experience sampling method

Background: Positive Working Alliance (WA) is linked to better treatment. Factors influencing WA between patients with Schizophrenia Spectrum Disorders (SSD) and staff are unclear. This study explores the relationship between WA and variables evaluated using the Experience Sampling Method (ESM). Methods: The final sample includes 55 patients and 43 staff members. ESM was used to track patients' daily activities and emotions during the day. Generalised Linear Models (GLM) were applied to investigate associations between WA and ESM variables, and k-means clustering was performed to group patients. Results: Patients hospitalized for 1-5 years are associated with lower patient-related WA ratings (p = 0.040), while staff-related WA ratings are positively influenced by time spent "Getting around" (p = 0.024), "With other people" (p = 0.006), and "Alone" (p = 0.031). Cluster analysis shows that comprising patients who mainly spend time alone, has more severe symptoms and a weaker WA than patients who spend more time with others. Discussion: Extended hospitalisation is linked to lower WAI-P ratings, due to reduced trust and disengagement. Conversely, greater social interaction and mobility are associated with improved WAI-P and WAI-T ratings, suggesting that social and functional activity strengthens the WA. These findings highlight the importance of interpersonal connection and autonomy in supporting effective therapeutic relationships.