Individual and Environmental Implications of Working Alliances in Occupational Therapy

Abstract

Introduction: The therapeutic alliance is constituted of two predominant actors, the client and therapist, and is embedded within a rich environment that may both facilitate and restrict the alliance development. Method: A mixed-methods, prospective, multiple case study approach was used to compare the contextual characteristics and experiences of the working alliance over the course of a community-based occupational therapy intervention by four dyads, each composed of an occupational therapist and client. Findings: The findings of this study suggest that there are a variety of therapist, client, and environmental factors that interact with one another, each having a different impact on the process of alliance development. Conclusion: Although therapists must shoulder the responsibility of creating a therapeutic atmosphere conducive to sound working alliance development, there are also elements having an impact on the alliance that are outside the therapist's control. Although these findings point to development potentials for therapists to consider, related to the therapeutic use-of-self, there is also a need for vigilance in relation to career health in assuming responsibility for elements that therapists cannot always mediate.