Child abuse and the working alliance between case managers and women in shelters.

摘要

This study examined whether Finkelhor and Browne's (1986) model, linking a history of childhood abuse to the traumagenic dynamics of powerlessness, betrayal and stigmatization, helped identify impediments to a healthy working alliance between case managers and their African American, homeless clients in an urban shelter. We hypothesized that a history of childhood abuse would be negatively associated with working alliance ratings; a history of childhood abuse would be positively associated with feelings of betrayal, powerlessness and stigmatization; and the traumagenic dynamics (powerlessness, stigmatization and betrayal) would mediate the relationship between an abuse history and the working alliance.;Consistent with previous studies, we found that women in this study had endured significant histories of childhood and adult victimization and these histories were associated with feelings of stigmatization. A history of physical abuse in childhood was also associated with feelings of powerlessness. We found that a history of childhood physical abuse contributed more variance in feelings of stigmatization than a history of childhood sexual abuse or their interaction. Protective factors that emerged regarding feelings of betrayal, stigmatization and powerlessness included education level, work history and age.;Contrary to expectations, working alliance ratings were not associated with a history of victimization (adult or childhood) or with feelings of betrayal, powerlessness or stigmatization. Client ratings of the working alliance were negatively associated with anxiety and hostility. Case manager ratings of the working alliance were significantly associated with the length of time and number of times a woman had been homeless. Clients appeared to perceive themselves as aligned with their case managers and working on relevant tasks, primarily associated with basic survival. A number of alternative explanations for these divergent findings are offered, as well as implications for future research and clinical practice.