The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs

Abstract

Purpose: The purpose of this study was to determine the relationship between the working alliance and employment outcomes in persons with severe mental illness receiving vocational services. Another purpose of this study was to determine whether working alliance differences exist between clients receiving evidence-based supported employment services and those receiving traditional stepwise vocational services.

Design: This study was a secondary analysis of a 2-year randomized controlled trial comparing two employment programs providing services to people with severe mental illness.

Results: Contrary to expectations, no overall relationship was found between the working alliance and employment outcomes. As predicted, supported employment participants each assigned to a single vocational worker had more positive working alliances than participants served by a team of vocational workers in the traditional vocational program.

Conclusions/implications: The lack of an association between the working alliance and employment outcomes is inconsistent with previous literature. Further research is needed using standardized working alliance measures and larger samples that include both working and nonworking clients. Evidence-based supported employment, which employs individual caseloads, seems to foster better relationships than a team-based vocational approach, although future research is needed to replicate this finding.