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Working Alliance and Stages of Change for Employment: The Intermediary Role of Autonomous Motivation, Outcome Expectancy and Vocational Rehabilitation Engagement

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Abstract

Purpose Working alliance is one of the most important common factors for successful counseling/psychotherapy outcomes. Based on the empirical literature about working alliance, it seems that self-determination and self-efficacy theory (SDT/SET) can potentially be used as a motivational model to explain the relationship between working alliance and vocational rehabilitation (VR) outcomes. The purpose of this study is to evaluate three primary SDT/SET constructs, autonomous motivation, expectancy and engagement, as mediators for the relationship between working alliance and stages of change (SOC) for employment. Methods A serial multiple mediation analysis (SMMA) was computed to evaluate autonomy, outcome expectancy, and VR engagement as mediators of the relationship between working alliance and SOC for employment in a sample of 277 people with chronic illness and disability (CID) receiving services from state VR agencies in the United States. Results The SMMA results indicated that working alliance was positively associated with SOC for employment (total effect), while the direct effect between working alliance and SOC for employment was not significant after controlling for the effects of the mediators, indicating significant mediation effects. The mediation effects were estimates of the indirect effects for working alliance on SOC for employment through (a) autonomous motivation, (b) outcome expectancy, (c) VR engagement, and (d) autonomous motivation, outcome expectancy and VR engagement together. Conclusions The results indicated that a strong working alliance has the benefit of helping consumers develop autonomous motivation to work and increasing their vocational outcome expectancy and engagement in VR services, leading to employment.

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Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available due to that we obtained informed consents from our participants on the condition that we use the obtained data for this study purpose but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. School of Allied Health and Communicative Disorders, Northern Illinois University, Wirtz Hall, DeKalb, IL, 60115, USA

    Kanako Iwanaga

  2. Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Education Building, 1000 Bascom Mall, Madison, WI, 53706, USA

    Fong Chan, Timothy N. Tansey & Malachy Bishop

  3. Department of Kinesiology and Community Health, University of Illinois, 213A Huff Hall MC-588, 1206 South Fourth Street, Champaign, IL, 61820, USA

    David Strauser & Ellen Ritter

  4. Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA

    Jessica Brooks

  5. Rehabilitation and Health Services, University of North Texas, Chilton Hall 218-G, 410 Avenue C, Suite 218, Denton, TX, 76203, USA

    Jessica Brooks

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  1. Kanako Iwanaga
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Correspondence to Kanako Iwanaga.

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Research Involving Human and Animals Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Iwanaga, K., Chan, F., Tansey, T.N. et al. Working Alliance and Stages of Change for Employment: The Intermediary Role of Autonomous Motivation, Outcome Expectancy and Vocational Rehabilitation Engagement. J Occup Rehabil 29, 315–324 (2019). https://doi.org/10.1007/s10926-018-9787-5

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