Implications of the Therapeutic Working Alliance in Holistic Neuropsychological Rehabilitation
Objective:
The purpose of this talk is to describe the structure of an intensive holistic neuropsychological rehabilitation day program with specific emphasis on the nature and effect of the therapeutic working alliance. Firstly, the characteristics of the working alliance will be described as this pertains to this form of rehabilitation. Secondly, implications for neuropsychological treatment will be considered and finally, outcome results will be presented.
Method:
(1) Two single case studies to illustrate the qualitative aspects of the working alliance.
(2) Retrospective ratings of quality of working alliance between therapist and adults with acquired brain injury (N=98) during a four month holistic neuropsychological rehabilitation program at the CRBI. Quality of working alliance was analyzed in relation to occupational and recreational outcome measured cross-sectional (mean follow-up length 16 months, SD 9 months).
Results: The case studies show the importance of the working alliance for the rehabilitation outcome. The retrospective analysis underlines this by showing a significant relationship between working alliance and follow-up outcome.
Conclusions:
Working alliance is essential for the effective treatment of brain-injured adults. Specifically, this pertains to the therapeutic facilitation of insight, coping abilities and management of emotional and social difficulties related to brain injury. The quality of the working alliance is of particular importance subsequent to completion of the formal rehabilitation process, i.e., in the follow-up phase, where contact is less frequent.