The alliance in psychiatric rehabilitation: client characteristics associated with the initial alliance and the relationship of the initial alliance to outcomes in a supported employment program
Cichocki, Benjamin John
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The therapeutic alliance is widely recognized as an effective component of therapeutic change. However, the topic has received very little attention within the context ofpsychiatric rehabilitation programs. The limited evidence available suggests that the alliance may be related to client outcomes within psychiatric rehabilitation programs, but there is no evidence as to which factors are related to the alliance within this setting. This dissertation consists oftwo studies intended to contribute to the limited knowledgebaseconcerningthiskeyconstructwithinpsychiatricrehabilitation. Both studies used previously collected and de-identified data made available for analyses by a supported employment program, a type ofpsychiatric rehabilitation program. Data were made available for 70 individuals served by the single employment specialist in the program. All data were captured upon intake by program administrative processes in place at that time, or were extracted from program administrative databases (for outcomes). Study 1 examined whether client characteristics found to be associated with the alliance across several populations or program types were associated with the initial alliance upon intake to the program. Study 2 examined the relationship between the initial alliance and program and employment outcomes six months after intake into the program. The initial alliance was ofinterest due to a recognized link between the early alliance and program retention for individuals with schizophrenia, one ofthe primary target populations for psychiatric rehabilitation programs. Study 1 found being older at intake and having a smaller social network size were significantly correlated with client self-report o f a high alliance at the bivariate level. A forward stepwise logistic regression analysis indicated that neither variable remained an independent predictor ofhaving a high alliance when controlling for the effects ofthe other. Study 2 found no significant relationships between a high initial alliance and program retention, amount ofservices received, or obtaining employment six months after intake through bivariate and linear or logistic forward stepwise regression analyses. These findings may have resulted from unexpectedly high alliance ratings, which limited the variability observed. The high ratings may have been due to social demand characteristics associated with how the measure was administered, the limited length of the relationship on which to base the ratings, or other factors. Future research should address these potentially important issues, and make use of alliance ratings at multiple time points, with multiple employment specialists in programs using evidence based supported employment models in order to maximize the utility of any findings to the field ofpsychiatric rehabilitation.
Thesis (Sc.D.)--Boston University