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

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.

Substance use outcomes for mindfulness based relapse prevention are partially mediated by reductions in stress: Results from a randomized trial.

OBJECTIVE: Mindfulness based relapse prevention (MBRP) has demonstrated efficacy in alleviating substance use, stress, and craving but how MBRP works for marginalized young adults has not been investigated. The current study used a novel rolling group format for MBRP as an additional intervention for young adults in residential treatment. We tested the hypothesis that MBRP (plus Treatment as usual (TAU)) would reduce stress, craving, and substance use among young adults in residential treatment relative to treatment-as-usual plus 12-step/self-help meetings (TAU only). Further, we examined whether reduced stress during treatment was a potential mechanism of change operating in MBRP. METHOD: Seventy-nine young adults (Mage = 25.3,SD = 2.7;35 % female) were randomly assigned to MBRP (n = 44) or TAU (n = 35). Follow-up assessments were conducted bi-monthly for self-reported measures of stress, craving, and substance use. RESULTS: At treatment completion young adults receiving MBRP had lower substance use (d = -0.58, [-0.91, -0.26]), craving (d = -0.58, [-1.0, -0.14]), and stress (d = -0.77 [-1.2, -0.30]) relative to TAU condition. Reduced stress during treatment partially mediated observed outcome differences between MBRP and TAU for substance use (ßindirect = -0.45 [-0.79, -0.11]). CONCLUSIONS: Results suggest that MBRP is a useful and appropriate intervention for marginalized young adults. Further, our results suggest that the effects of MBRP on long-term substance use outcomes may be partially explained by reduced stress.