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

Posted by Justin | July 28, 2007 .

The relationship between the counselor and client should be investigated. This relationship, termed the working alliance, consists of mutual trust, respect and involvement in the counseling process. It signifies the existence of a collaborative counseling process, which engages the client and facilitates successful outcomes. The working alliance that is developed and maintained throughout the counseling process between the counselor and the client contains pertinent information that may provide some explanation of what occurs that makes rehabilitation outcomes for this population mostly unsuccessful. The current study investigates the relationship between the working alliance and rehabilitation outcomes for persons with severe mental illness (SMI).

Research conducted by the National Alliance for the Mentally Ill (NAMI, 1997) on employment success for this population within the vocational rehabilitation system reinforces the reality of low employment rates for this population and provides evidence that persons with severe mental illness experience less success at becoming vocationally rehabilitated than most other persons with disabilities (Rogers, Anthony, Toole & Brown, 1991). NAMI (1999) contends that the state-federal public rehabilitation program has failed through their service delivery program to increase the employment rates of persons with severe mental illness. There still exists the challenge to improve the quality and consistency of employment outcomes for this population.

The 1998 Amendments to the Rehabilitation Act stated that individuals with disabilities served in the State-Federal rehabilitation system must be “active and full partners” in the vocational rehabilitation process. Client involvement in the rehabilitation counseling process has been reported as an important factor in increasing the likelihood of successful employment outcomes (Chan, Shaw, McMahon, Koch, & Strauser, 1997). Therefore, a key factor in the development of the client as an active participant in the vocational rehabilitation process is fostering a working alliance between the client and counselor.

As Bolton, Bellini and Brookings (2000) suggested, an important focus of research has been to determine variables that influence successful employment outcomes. Previous studies have typically focused on consumer demographic characteristics as variables, such as: previous employment history, psychiatric diagnosis, ethnicity, gender, marital status, living arrangements, and recidivism. One variable is the counselor-client relationship (i.e., the working alliance) and the value it may have for enhancing employment outcomes for people with SMI. What this seems to call for across rehabilitation models, is the need for attention to individual needs and concerns, an emphasis on the quality of the relationship between the client and the counselor, as well as an understanding of the individuals’ perception of the benefit of rehabilitation services. It is imperative within a rehabilitation service model that is client-centered to not ignore the consumer’s subjective views regarding the impact of the services they receive (Lustig & Crowder, 2000). Understanding the nature of these factors could potentially yield valuable information toward interventions that may increase employment outcomes for persons with severe mental illness.