Principle 2 Collaboration and autonomy support

While a recovery process is personal, it need not be isolated. CRM recognizes the benefit of an effective working alliance. Hence the term Collaborative Recovery—a dialectic between a person who is recovering and one or more persons assisting this process.


A substantial psychotherapy research literature has consistently found a significant relationship between the strength of the working alliance and mental health outcomes (e.g. Martin, et al., 2000). There is also growing evidence that the strength of the working alliance between workers and mental health service consumers has a significant impact on case management of serious mental illness outcomes (Howgego, et al., 2003).


Working Alliance

Collaboration between therapist and clients in relation to:

  • Establishment of, and agreement on, the therapy GOALS,
  • agreement on the appropriateness and efficacy of the therapy TASKS,
  • and the relational BONDS between the therapist and client.

Goals – the target of the intervention, or what is wanted as a result of rehabilitation/therapy.
Tasks – the in-counselling or case management behaviours and cognitions that form the substance of the helping process.
Bonds – embraces the network of positive personal attachments between client and therapist that includes issues such as mutual trust, acceptance and confidence. Issues of transference and genuine person-to-person contact impacts may also influence this aspect of the working alliance.


Alliance Ruptures

  • Consists of an impairment or fluctuation in the quality of alliance between the therapist and the client
  • Alliance ruptures are common
  • Is always an interactional phenomenon, a function of both client and therapist contributions. (Safran & Muran, 1996)
  • They vary in intensity, duration and frequency depending on the particular therapist – client dyad. These can be divided into two categories:
    • Confrontation – client may express negative thoughts and feelings toward the therapist, and/or terminate therapy prematurely
    • Withdrawal – often difficult to detect
      (Safran, et al., 1990; 1996)
  • Early detection of alliance ruptures by the therapist is critical to successful therapy
  • Resolution or healing of alliance ruptures can be potent change events
  • Impact of therapists behaviour on the client needs to be understood in terms of client’s perception of therapist’s behaviour, based on client’s relational history (Safran, et al., 1990)


The term autonomy support is drawn from Self-Determination Theory, and involves three components: (a) taking the perspective of the consumer; (b) providing choice to the consumer; and (c) providing a rationale to the consumer for what is occurring. Sheldon et al. (2003) emphasize that being autonomous or self-determined does not mean being isolated or independent of others.

   

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