The working alliance: rehabilitation outcomes for persons with severe mental illness

Journal of Rehabilitation, April-June, 2004 by Chandra M. Donnell, Daniel C. Lustig, David R. Strauser

Finally, while this study found no significant differences based on ethnicity, given recent research into race and ethnic differences in rehabilitation outcomes (Wheaton, 1995; Wheaton, Wilson, & Brown, 1996; Wilson, 1999; Wilson, 2000) it would appear relevant for future studies to also examine the impact of ethnicity on the working alliance. Additionally, this further examination of the impact of ethnicity on the working alliance, should be reviewed from the perspective of the counselor as well as the client.

Conclusion

The results of this study mirror those of other studies on this population and illustrate that the development of the working alliance is central to the overall success of outcomes for persons with severe mental illness. If clients have stronger working relationships, they may be able to use the treatment to improve their lives to such a degree that they experience a more general satisfaction with life and better employment outcomes. Again, a strong relationship with the counselor can assist the client in social interactions and situations that exist beyond the counseling process. Specifically, for a group that lacks a "predictive nature" of the disability, the therapeutic relationship may become more central to long-term care situations. The correlation between the working alliance and future employment prospects indicates both the immediate benefit of a strong working alliance within the counseling relationship, but also the long-term implications for rehabilitation clients with severe mental illness. Chinman et al. (2000) concluded that the strength of the working alliance is relevant not only to the clients progress during therapeutic treatment, but also assists with improving their lives and has implications for increasing general satisfaction with life. This study reiterates the benefit of developing a strong working alliance with persons with psychiatric disabilities and prompts for further investigation into this construct and the potential implications for increasing successful outcomes.

Table 1
Demographic Characteristics of Participants

                               Total sample            Employed
                                 (N = 305)            (n = 111)

Age                          37.7 (M) (9.9(SD)    35.7 (M) 10.2 (SD)
18 - 25                      43%                      20%
26 - 40                      45%                      47%
41                           41%                      33%
% female                     60                       65

Ethnicity
  Caucasian                  74%                      26%
  African-American           19%                      71%

Marital status
  married                    18%                      22%
  widowed                     3%                       3%
  divorced                   28%                      30%
  separated                   7%                       3%
  never married              44%                      37%

Education
  < High School Diploma      37%                      39%
  High School Diploma        46%                      45%
  Post High School           17%                      16%
  Special education          <1%                      <1%

% secondary disability       36                   43

                                Unemployed
                                 (n = 194)

Age                          38.9(M) 9.6 (SD)
18 - 25                           11%
26 - 40                           42%
41                                47%
% female                          58

Ethnicity
  Caucasian                       81%
  African-American                29%

Marital status
  married                         16%
  widowed                          3%
  divorced                        27%
  separated                        9%
  never married                   45%

Education
  < High School Diploma           35%
  High School Diploma             46%
  Post High School                18%
  Special education                1%

% secondary disability       32

Table 2
Working Alliance Survey items

1. Did the vocational rehabilitation counselor and staff seem
 committed to helping you find a job?
2. Did your counselor try to match your skills with the jobs
 available at the time?
3. Did your counselor try to understand your problems and needs?
4. Did your counselor help you try to solve your problems?
5. Did your counselors and staff treat you with dignity and respect?
6. Did you feel that you received all the services specified in
 your rehabilitation plan?
7. How involved were you in developing your vocational goals?
8. How involved were you in selecting your program services?
9. How involved were you in developing your service providers?