Although there is a growing evidence base that supports the importance of the client-provider relationship for outcomes in community-based services for persons with serious mental illness, little research attention has been given to the precursors of this relationship. This study represents an attempt to identify provider-related factors that influence the interpersonal context of service delivery and pays particular attention to providers' patterns of thinking about challenging client behaviors. Specifically, it examines the impact of provider causal explanations, or attributions, for a common challenging client behavior, medication nonadherence, on the quality of the working relationship.

Data were collected from 152 client-provider dyads from a large, urban, community mental health clinic. Focal independent variables capturing aspects of providers' attributions for client medication nonadherence were derived from providers' written responses to a question eliciting reasons why clients may not take medications as prescribed. Using both a novel approach and a modified version of an established method of coding attributions, provider responses were rated to measure multiple dimensions of their attributional patterns. Bivariate, OLS regression, and HLM analytic strategies were used to examine the impact of these provider attribution patterns of the quality of the client-provider relationship.

Results indicated that client experience of the negative relationship was impacted by both the complexity and content of providers' attributions. Specifically, clients perceived less criticism and rejection when their providers generated a greater number of explanations for client medication nonadherence and when those explanations included mention of client beliefs about their illness and medication. Provider perception of the negative relationship was impacted by the dimensionality of provider attributions. That is, providers who generated causal explanations external to the client perceived less conflict and demoralization in their relationships with clients. Finally, provider perceptions of the positive relationship were impacted again by the content of their attributions. In this case, providers who acknowledged pragmatic impediments as possible causes of medication nonadherence perceived greater levels of satisfaction and connection in their relationships with clients.