Therapeutic relationships: their specificity in predicting outcomes for people with psychosis using clinical and vocational services

Soc Psychiatry Psychiatr Epidemiol. 2010 Dec;45(12):1187-93. doi: 10.1007/s00127-009-0163-9. Epub 2009 Nov 14.

Abstract

Objective: To determine the distinctions between the client-keyworker relationship and the client-vocational worker relationship by assessing their impact on clinical outcomes and exploring the associations between the two.

Methods: As part of an international randomised controlled trial of supported employment (n = 312), client-keyworker relationship and client-vocational worker relationship were each tested against clinical and social functioning 6 months later. Associations between the two relationships over time were explored.

Results: Client-keyworker relationship predicted quality of life, while client-vocational worker relationship, as rated by the client, did not predict any clinical or social functioning outcomes. Vocational worker-rated relationship predicted reduced depression. The client-keyworker and client-vocational worker relationships were correlated, but this did not change over time.

Conclusion: The impact of the client-vocational worker is likely to be on the shared task of finding employment, rather than on clinical and social functioning. Good client-vocational worker relationships do not detract from client-keyworker relationships.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Community Mental Health Services / methods
  • Employment, Supported / methods*
  • Follow-Up Studies
  • Humans
  • International Cooperation
  • Multicenter Studies as Topic / statistics & numerical data
  • Patient Satisfaction
  • Physician-Patient Relations
  • Professional-Patient Relations*
  • Prognosis
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / psychology
  • Psychotic Disorders / rehabilitation*
  • Psychotic Disorders / therapy*
  • Randomized Controlled Trials as Topic / statistics & numerical data
  • Rehabilitation, Vocational / methods*
  • Rehabilitation, Vocational / psychology
  • Social Support
  • Treatment Outcome