Therapeutic relationships: their specificity in predicting outcomes for people with psychosis using clinical and vocational services

Objective To determine the distinctions between the client– keyworker relationship and the client–vocational worker relationship by assessing their impact on clinical outcomes and exploring the associations between the two. Methods As part of an international randomised controlled trial of supported employment (n = 312), client–keyworker relationship and client–vocational worker relationship were each tested against clinical and social functioning 6 months later. Associations between the two relationships over time were explored. Results Client–keyworker relationship predicted quality of life, while client–vocational worker relationship, as rated by the client, did not predict any clinical or social functioning outcomes. Vocational worker-rated relationship predicted reduced depression. The client–keyworker and client–vocational worker relationships were correlated, but this did not change over time. Conclusion The impact of the client–vocational worker is likely to be on the shared task of finding employment, rather than on clinical and social functioning. Good client– vocational worker relationships do not detract from client– keyworker relationships