| Sumario: | The purpose of the study was to revisit an old debate about the meritorious effects of treatment for individuals with severe mental illness and the deleterious effects of the treatment label by looking at treatment processes and self-stigma of mental illness among individuals with severe mental illness. The relative impacts of two treatment related variables, case managers and working alliance, and self-stigma (fear of rejection) on perceptions of quality of life among consumers of community menial health case management was explored. Data was collected from 160 consumers. Analysis of the data indicated that both working alliance and fear of rejection were significantly and oppositely related to quality of life. Self-stigma was negatively related to quality of life and working alliance was positively related to quality of life. Case managers impacted consumer perceptions of quality of life through consumers' fear of rejection. Some case managers were able to mitigate and others amplified the effects of fear of rejection on quality of life. Findings from this study add to the labeling debate and support and add to past research into the joint effects of treatment and self-stigma. The study provides new insight into the effects of treatment providers on self-stigma. The results suggest the need for training case managers to develop recovery oriented relationships with consumers and monitoring the case manager/consumer relationship by supervisors. Finally, the findings suggest that case managers should be included in effectiveness studies of models of case management because they do interact with consumer attributes and perceptions.
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