The working alliance in supported employment for people with severe mental health problems

Abstract

Aims This study examined the utility of the Working Alliance Inventory Short form (WAI-S) for measuring the working alliance between supported employment service providers and service users with severe mental health problems. Methods Service users (n=32) and their respective service providers (n=17, 32 pairs) from five supported employment services independently rated their working alliance using the WAI-S. Findings There was little correlation at item, factor, and total score levels, and low agreement between service users and service providers on 11 of 12 working alliance items of the WAI-S. Conclusions These findings challenge the validity of the working alliance construct in this context, suggesting that both the WAI and the WAI-S may not be optimal measures of the working alliance in supported employment. The contextual differences between psychotherapy and supported employment, and the greater divergence of user-provider perceptions, imply that the working alliance in supported employment may differ from the alliance in psychotherapy. Researchers are encouraged to investigate the nature of the working alliance in supported employment rather than project characteristics identified in other settings.