Psychotherapy as an element in supported employment for persons with severe and persistent mental illness

RECENT literature has urged that vocational and clinical services for perso ns with severe and persistent mental illness should be integrated. Unclear in this model is what role psychotherapy could play. In particular, it is u nknown whether psychotherapy can make a unique contribution and whether the re are issues it might systematically address in the context of vocational rehabilitation. To examine these questions we report on the psychotherapy o f six consumers enrolled in supported employment, a prominent form of vocat ional rehabilitation. Using these cases as illustrations, we suggest that i n an integrative team approach, psychotherapy can facilitate vocational reh abilitation by helping consumers reconstruct aspects of personal narratives related to disability and work and by processing painful affects evoked by work. We report how within a reflective and nonhierarchical relationship c onsumers were allowed to reframe old ideas, question inconsistencies, and k eep track of the structure and content of revised narrative until fully int egrated into memory. Despite a wide range of severe impairments, this proce ss enabled consumers to incorporate work into a now more complete and coher ent life narrative. Implications for practice and research are discussed.