Change in working alliance and recovery in severe mental illness: an exploratory study

Consumer-defined recovery from schizophrenia spectrum disorders and other recurring psychotic illnesses ("serious mental illness", "SMI") emphasize re-establishment of a personally meaningful life. The working alliance ("the alliance") is highlighted as important in facilitating recovery, however there is little empirical evidence concerning the relationship between the alliance and recovery in populations with SMI.

The aim is to explore the relationship between the alliance and recovery over time in a sample with SMI.

Sixty-one individuals with SMI receiving case management support from mental health services in Australia were recruited by their mental health workers and completed measures of working alliance and recovery. Measures were collected by the workers during regular counselling sessions on two separate occasions. The average time between measurement times was 6 months apart.

Multiple regression analyses indicated that changes in the alliance predicted recovery, but changes in recovery also predicted the alliance. No definitive conclusions regarding the causal direction of the relationship between the alliance and recovery could be drawn.

The results provide preliminary evidence that improvement in the alliance positively influences gains in recovery and that gains in recovery also facilitate stronger alliance in SMI. These findings support an emphasis on the alliance.