The Impact of the Working Alliance on Vocational Outcomes for People with Severe Mental Illness Enrolled in Employment Programs

Abstract

This study was a subset of a large two-year randomized controlled trial of two employment programs providing services to people with severe mental illness (SMI). Because prior research has found that the strength of the relationship, or working alliance, between service providers and people with SMI is related to a variety of beneficial outcomes, the purpose of the current study was to address the working alliance between participants and their vocational workers and its association with employment outcomes, including the total duration of paid employment over two years and mean paid job tenure after two years. Another primary purpose of the current study was to determine whether working alliance differences exist between a team vocational approach (Diversified Placement Approach) and an individual vocational approach (Individual Placement and Support Model). The final aim of the current study was to investigate the psychometric properties of the ad hoc scale utilized to measure the working alliance. Contrary to expectations, no relationship was found between the working alliance and employment outcomes after two years. As expected, it was found that participants in the individual vocational approach (IPS) had higher working alliance scores across the study than participants in the team vocational program (DPA). Finally, the working alliance measure used in this study was found to have promising psychometric properties, including adequate criterion-related validity and test-retest reliability, although the internal consistency was a bit low. The scale items are a loose fit with existing theory, however, necessitating the addition of items and revision of the current scale and underlying theory to enhance its utility in clinical and research settings.