Perceptions of the Ways of Mattering by people with mental illness.

The Ways of Mattering questionnaire (N. E. Amundson, 1993,2003) was developed to evaluate clients' perceptions of a counseling relationship. This study reports the construct and convergent validities of the Ways of Mattering as well as the internal consistency of each of its subscales for people with mental illness who were registered in supported employment programs. The questionnaire demonstrated satisfactory validity and reliability with this population. The instrument could be useful for identifying the basic and positive elements required to establish a solid foundation for developing a working alliance between the counselor and the client.

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As researchers evaluate the essential components of helping others, the relationship between the client and the person in the helping role is repeatedly identified as an essential factor (Henry, Strupp, Schacht, & Gaston, 1994). In several meta-analyses, this relationship stands out as a central component in all forms of counseling and therapy (Horvath & Symonds, 1991; Martin, Garske, & Davis, 2000). Skovholt, Ronnestad, and Jennings (1997) stated emphatically that the single most important factor in counseling or psychotherapy is the ability to establish a positive working relationship.

In attempting to describe this relationship, researchers have focused on various qualities of caring, such as warmth, support, attention, understanding, and acceptance (Day, 2004). They have also examined the ways that counselors and clients have bonded through shared goals and tasks. Bordin (1979) was one of the first researchers to use the term working alliance to begin to define the essential qualities of the relationship. Meara and Patton (1994) reported that the working alliance was characterized by collaboration, mutuality, and cooperation between the client and the counselor. The working alliance has also been described as the result of a mutual investment by the client and the counselor or another vocational professional (e.g., an employment specialist), and the alliance can be built at each meeting on the basis of affective and concrete goals and task-related concerns (Horvath & Greenberg, 1989). The beneficial role of an alliance between counselors/therapists and clients in vocational and psychotherapeutic processes is also widely recognized for persons with mental illnesses (Gaston, 1990; Gehrs & Goering, 1994; Horvath & Luborsky, 1993; Martin et al., 2000; Neale & Rosenheck, 1995; Svensson & Hansson, 1999; Tyrrell, Dozier, Teague, & Fallot, 1999).

Another important element of the client-counselor relationship is the way that significance is communicated through interpersonal exchange. Rosenberg and McCullough (1981) used the term mattering to describe the feeling that people have when they sense that others are interested in them and value their contribution. When people believe that they matter, they feel that they belong and that others appreciate them. Rosenberg and McCullough's research indicated that adolescents who felt that they mattered were less likely to commit delinquent acts. Schlossberg, Lynch, and Chickering (1989) indicated that the concept of mattering could be applied to adult students in a higher education setting. Amundson (1993) suggested that the principles of mattering could be applied to unemployed clients, and Connolly and Myers (2003) connected this concept with workplace wellness. Of all the environmental or social determinants of work integration for people with mental illness, the concept of mattering between the client and the employment specialist warrants further investigation.

Schlossberg et al. (1989) extracted from the work of Rosenberg and McCullough (1981) a series of dimensions associated with mattering. Four of these dimensions can be summarized as follows:

1. Attention: The feeling that someone notices or is interested in you. For example, when you enter a room, people acknowledge your presence and make you feel welcome.

2. Importance: The sense that people are interested in what you are thinking, feeling, and doing. This aspect is communicated when people inquire about your well-being and take the time to listen carefully to what you have to say.

3. Dependence: The feeling that your contribution is valued and needed. You may be a member of a team and feel that everyone is counting on your participation for the development of ideas.

4. Ego-Extension: The feeling, whether right or wrong, that others are interested in how you are doing (accomplishments as well as disappointments), even when there is no longer a professional relationship.

Amundson (1993) described how these dimensions have relevance to clients as well as to counselors. In any counseling situation, there is a parallel relationship as clients look to counselors for a sense of mattering and counselors look to their colleagues and supervisors for similar recognition. The purpose of this study was to explore how the Ways of Mattering questionnaire (Amundson, 1993, 2003) can be used with clients who are mentally ill and who are in supported employment counseling. As part of the validation process, a measurement of the working alliance was also used.

Method

Participants and Procedure

People with mental illness who were registered in supported employment programs in Vancouver (British Columbia, Canada) were invited to complete the Ways of Mattering questionnaire. A supported employment program was defined as an evidence-based practice that helps people with mental illness find and keep competitive employment (Corbiere, Bond, Goldner, & Ptasinski, 2005). Employment specialists, who usually have mental health and counseling backgrounds, helped people with mental illness look for jobs soon after the individuals entered the program; the individuals were not required to complete extensive preemployment assessment and training. The support continued for as long as the clients wanted assistance (for more details, see Substance Abuse and Mental Health Services Administration, 2003).

The consenting participants were seeking a job, were diagnosed with a mental disorder, and spoke and read English (N = 196). Their cultures/ethnicities were Canadian (n = 140, 71.4%), European (n = 14, 7.1%), East Asian (n = 12, 6.1%), Aboriginal/First Nations (n = 8, 4.1%), and other cultures (e.g., American, South Asian; n = 13, 6.6%); 9 participants (4.6%) did not specify their culture/ethnicity. (Percentages do not equal 100% because of rounding.) Participants were 102 women and 94 men (average age = 38.2 years, SD = 10.3); most of the participants (n = 126, 64.3%) were single. Thirty of the participants (15.3%) had completed some high school or less, 34 (17.3%) had completed high school, 55 (28.1%) had attended college, and 77 (39.3%) had attained a university-level education. The participants' mental status included mood disorders (n = 102, 52.0%); schizophrenia or other psychotic disorders (n = 41,20.9%); anxiety disorders (n = 30,15.3%); and other diagnoses, mainly personality disorders (n = 23, 11.7%). (Percentages do not equal 100% because of rounding.) The mental status of participants was obtained from a self-report measure. The length of absence from the workplace (i.e., the number of years since the individual was last employed) was 1 year or less (n = 81, 41.3%), 1-2 years (n = 25, 12.8%), 2-5 years (n = 32, 16.3%), and more than 5 years (n = 30, 15.3%); 4 participants (2.0%) had never worked, and 21 (10.7%) were currently employed. Employment information was not available for 3 participants (1.5%). (Percentages do not equal 100% because of rounding.)

Employment specialists from the aforementioned supported employment programs were asked to recruit individuals who were willing to participate in a large study (Corbiere & Goldner, 2003). Participants were administered the Ways of Mattering and the Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) along with other cognitive tests and questionnaires to better understand the work integration determinants for this population.

Instruments

Ways of Mattering questionnaire. The original 24-item version of the Ways of Mattering questionnaire (Amundson, 1993) was adapted in this study for people with mental health problems who were registered in supported employment programs (see Appendix). Amundson (1993,2003) designed the questionnaire to assess each of the previously mentioned four dimensions: Attention, Importance, Dependence, and Ego-Extension. All four dimensions of the Ways of Mattering include 6 items, 3 that are phrased negatively, and 3 that are phrased positively. To obtain an overall positive score, it was necessary to reverse score the items that were written in the negative direction. Participants were asked to respond on a Likert-type scale (1 = very seldom, 5 = very often) regarding the extent to which each item "describes the relationship."