Expanding Understanding of Mental Health Recovery: Effects of Stigma and Working Alliance on the Quality of Life of Persons with Severe Mental Disabilities Receiving Community-Based Services

Statement of the research problem Over the past few decades community mental health treatment has gone through a paradigmatic shift. This paradigm is called recovery in mental health. Rather than merely maintaining persons with severe mental illness (SMD) in the community, this new paradigm seeks the full participation of person with SMD in community life (Kruger, 2000). While hard to define, recovery in mental illness may best be understood from the perspective of those individuals who are engaged in the recovery process (Anthony, et al., 2003). One indicator of recovery that captures consumers ’ own understanding of their recovery process is consumers ’ sense of their quality of life (Liberman, & Kopelowicz, 2004). The recovery movement has challenged practitioners and researchers to develop a deeper understanding of the treatment related factors that facilitate recovery and the environmental factors that stand as barriers to recovery (Loveland et al., 2002). Past research suggests that strong working alliances between mental health case managers and their consumers is one treatment related factor that has a powerful and positive effect on consumers ’ recovery chances. Conversely, self-stigma, which is a process whereby persons labeled with a mental illness come view themselves as their label, has a detrimental effect on consumers and their recovery chances Research Background and Research Questions While initially conceived as a process related factor in psychotherapy, researchers have explored the effects of working alliance in the context of case management and have used Bordin’s definition of this concept (Howgego et al., 2003). Bordin (1979) conceptualized the working alliance as consisting of three components: a) the therapist’s and client’s agreement on the goals of therapy; b) the therapist’s and client’s agreement on the tasks of therapy; and c) the positive bond that exists between the therapist and the client. He viewed his understanding of the working alliance as being pan-theoretical an