THE EFFECT OF WORKING ALLIANCE ON CLIENT DROP- OUT FOR PERSONS WITH ...

167 Pages·2007·2.06 MB·English

ABSTRACT

Title of Dissertation : THE EFFECT OF WORKING ALLIANCE ON CLIENT DROP-

OUT FOR PERSONS WITH DISABILITIES IN STATE-

FEDERAL REHABILITATION AGENCY

Mary Stapleton, Doctor of Philosophy,2007

Dissertation directed by: Associate Professor Ellen S. Fabian
Department of Counseling and Personnel

The existence of a working alliance between a counselor and a client has been
viewed as a critical component of the therapeutic process in the psychological literature
(Bachelor, 1995). The construct of working alliance has been the focus of interest in
research literature as a measure of positive therapy outcomes. According to Horvath
(2001 ) two decades of empirical research have consistently linked the quality of the
alliance between therapist and client with therapy outcome. The 1998 Amendments to the
Rehabilitation Act mandate that persons with disabilities must be “active and full
partners” in the rehabilitation process. In the federal-state rehabilitation setting there is
limited time to form an alliance( Safran&Muran, 1998), so that the initial interview
becomes critical in engaging the client in this process. Therefore, this study measured
the working alliance after the initial in-take session.
Working alliance was measured by the Working Alliance Inventory (WAI)
developed by Horvath & Greenberg (1989). The dependent variable was the
Individualized Plan for Employment (IPE) which represents the agreed upon goals and
tasks between the DORS counselor and client. The major hypothesis was that a strong
working alliance between counselor and client would predict an IPE, and a poor alliance
would not.
The study participants were 111 persons with disabilities who applied and were
found eligible for services in FY 2006 through the Maryland Division of Rehabilitation
Services (DORS). The investigation was conducted at 16 DORS offices throughout the
state .
The major finding was the lack of any significant relationship between working
alliance and IPE . The second major finding was the clients gave generally high WAI
scores to DORS counselors and 59 % (66) had an IPE. Despite this positive finding ,
those with high WAI scores were no more likely to have an IPE .Additionally, there was
an effect of disability category upon the WA. In summary, the findings suggest that
factors external to the WA may be more significant barriers to employment outcomes for
DORS clients. The implications for people with disabilities, counselors, and counselor
educators are discussed within the context of these findings.
THEEFFECTOFWORKINGALLIANCEON CLIENT DROP-OUT FOR
PERSONSWITHDISABILITIES INASTATE-FEDERALVOCATIONAL
REHABILITATIONAGENCY
by
MaryStapleton
DissertationsubmittedtotheFacultyoftheGraduateSchool ofthe
UniversityofMaryland,CollegePark,inpartial fulfillment
oftherequirements forthedegreeof
DoctorofPhilosophy
2007
AdvisoryCommittee:
AssociateProfessorEllenFabian,Chair
ProfessorEmeritus Paul Power
Assistant ProfessorKim MacDonald-Wilson
AssociateProfessorHanneMawhinney
Dr.JoAnnHutchinson
Assistant DirectorofDisabilityStudent Services
ii

DEDICATION

For my father Joseph Raymond Stapleton,

with love and gratitude

ACKNOWLEDGEMENTS
iii

The completion of a dissertation is a long and winding journey. There are so
many who have traveled it with me, shown me the way, provided maps, picked me up
when I stumbled, cheered me on , or in many uncounted ways provided support.
Foremost among these was my father who believed in me throughout, but who was not
able to be there to celebrate the end of this journey with me. To my mother who is my
best public relations specialist, many thanks.
I first must thank my advisor Dr.Ellen Fabian for keeping me on track as a
“returning student”, who had many hurdles to negotiate and many detours to avoid in
order to arrive at my destination.
My heartfelt thanks to Dr. Rick Parente’ who has been my spirit guide and
pathfinder through the field of psychology and academe and without whom I would have
been overwhelmed by the complexity of this journey. I thank Rick for his never-ending
support, generosity and sense of humor.
I wish to thank my friend Mary Sands who, throughout the many years of the
pursuit of this degree, has been the wind beneath my wings and the source of endless
support. I have been surrounded by positive energy from Fran Palazzolo, Joanne Weller,
Carol and Mark Wheatley, Nell and Victor Wilcox, Jackie Hart, Rosanne Zagorski, Dr
Pat Shipman., and last but not least from Lily, Jellica, Storm and Brook.
This research could never have been accomplished without the support of the
entire Division of Rehabilitation Services. Special thanks to Robert Burns, Assistant State
Superintendent in Rehabilitation Services, Ron Winter, Director of Field Services, Jean
iv
Jackson, Director of the WorkForce and Technology Center, Brenda Isennock, Assistant
Director of WTC, and finally Dr. Maya Desai, Medical Director of WTC.
Most of all I wish to thank the persons with disabilities and the many DORS
counselors who agreed to participate in this research.
v
Table of Contents

Chapter I: Introduction..............................................................................................1
Statement of the Problem.....................................................................................1
The Federal-State Vocational Rehabilitation System....................................2
Overview of the VR Process..........................................................................3
The initial interview.................................................................................5
Rehabilitation Outcomes................................................................................6
Importance of the working alliance in the VR process............................6
The drop-out problem in Maryland VR...................................................7
The drop-out problem in the VR National Longitudinal Study...............7
Factors associated with drop-outs............................................................8
Likelihood of receiving VR services.......................................................9
Ramifications of the Drop-out Problem.........................................................10
Relationship Between the WA and VR Counselor Time Constraints...........10
Importance of the WA in Improving VR Outcomes......................................12
Need for Study.....................................................................................................13
Purpose of Study..................................................................................................14
Relationship of the WA to the Drop-out Problem.........................................14
Context of the Study............................................................................................15
Rehabilitation Legislation..............................................................................15
Americans with Disabilities Act of 1990.......................................................16
1992 Amendments to the Rehabilitation Act.................................................16
Qualified VR counselors..........................................................................17
Consumer choice......................................................................................17
Practical Significance of the Study......................................................................18
Research Questions..............................................................................................19
Limitations of Study............................................................................................19
Definitions............................................................................................................20

Chapter II: Literature Review...................................................................................23
Development of WA............................................................................................23
The WA and the Common Factors Model...........................................................24
The WA as a Common Factor in Psychotherapy Outcome.................................25
Definition of the WA...........................................................................................28
History and Development of Alliance Theory.....................................................31
Goals and Tasks in Bordin’s WA Theory............................................................33
Factors That Affect the WA.................................................................................35
Effect of WA on Counseling Outcome................................................................35
Effect of WA on a Rehabilitation Outcome.........................................................36
WA and Counselor Expectations in VR..............................................................38
Variables That Affect Successful Rehabilitation Outcomes................................39
Client Variables............................................................................................40
Demographic Variables……………………………………………………41
VR Counselor Education Variables..............................................................42
Measurement of the WA......................................................................................43
vi
Working Alliance Inventory................................................................................44
Development of the WAI..............................................................................44
Validity of the WAI......................................................................................45
Reliability of the WAI.................................................................................46
Independence of the WAI Dimensions........................................................46
Outcome and the WAI.................................................................................47
WAI in Cognitive-Behavior therapy............................................................48
Summary..............................................................................................................49

Chapter III: Design and Methodology......................................................................55
Design..................................................................................................................56
Participants...........................................................................................................56
Instrument............................................................................................................60
WAI-C-S…………………………………………………………………. 60
Participants’ Personal Data..........................................................................61
Outcome Data...............................................................................................62
Procedures............................................................................................................63
Access and Planning......................................................................................63
Training Surveyors in the WAI......................................................................64
Data Collection/ Time Line...........................................................................65
Variables........................................................................................................66
Dependent Variable..............................................................................66
Independent Variables..........................................................................66
Data Analysis.......................................................................................................67
Power Analysis..............................................................................................67
Statistical Analysis………………………………………………………….68

Chapter IV: Results....................................................................................................72
Introduction..........................................................................................................72
Research Question Analysis................................................................................80
Research Question 1....................................................................................80
Research Question 2....................................................................................87
Research Question 3....................................................................................90
Post Hoc Analysis................................................................................................94
Counselor Variable......................................................................................94
Factor Analysis............................................................................................96

Chapter V: Discussion...............................................................................................101
Summary and Interpretation of Results..............................................................102
Research Question 1...................................................................................102
Research Question 2...................................................................................108
Research Question 3...................................................................................110
Disability Variable......................................................................................112
Counselor Variable.....................................................................................114
Factor Analysis...........................................................................................117
Limitations..........................................................................................................117
vii
Sample Concerns......................................................................................118
Instrumentation and Measurement............................................................119
Design.......................................................................................................120
Implications of Findings.....................................................................................123
Theoretical Implications..........................................................................123
Implications for Counselors.....................................................................123
Applied Implications................................................................................124
Implications for Counselor Educators.....................................................125
Directions for Future Research...........................................................................130

Appendix A: Characteristics of Persons Rehabilitated Under the Maryland
VR Program.......................................................................................................134
Appendix B: WAI-C Survey Instrument...................................................................137
Appendix C: WAI-C Scoring Key………………………………………………… 142
Appendix D: Limited Copyright License WAI……………………………………. 143
Appendix E: IRB Consent Form …………………………………………………. 144

References..................................................................................................................145
viii
List of Tables

Table Page

1 Aggregate Correlation Coefficients of Alliance and Outcome
by Rater Perspective.......................................................................................26

2 Relationship Between WAI and Outcome.....................................................47

3 Sample Characteristics and DORS................................................................57

4 Counselor Characteristics..............................................................................59
5 WAI Total and Score.....................................................................................74
6 Mean of WAI Questions by IPE....................................................................75
7 WAI Total and Subscale Means by Gender...................................................76
8 WAI by Race..................................................................................................77
9 WAI Total and Subscales by Disability.........................................................78
10 Classification Using WAI Variables..............................................................80
11 Logistic Regression Model on IPE by WAI Scores.......................................81
12 Model Summary.............................................................................................81
13 Logistic Regression Model on IPE................................................................83
14 Model Summary with Gender, Race, and Disability.....................................84
15 Primary Disability by IPE Cross-tabulation..................................................85
16 Chi-square Tests on Disability.......................................................................87
17 Pearson Correlation for WAI by IPE, Disability, Race, and Gender.............89
18 Effect Size of Variables on WA Scores.........................................................92
19 WAI Total Score by Disability Code.............................................................93
20 MLR Summary of WA Total Score by Counselor Code...............................95