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."

WAI. The WAI reflects the quality of the client and clinician's therapeutic relationship concerning three dimensions: bond, task, and goal. The short form of the WAI, for which 12 items were drawn in equal proportion from the three initial subscales, was used for the present study (Tracey & Kokotovic, 1989). The items were rated on a Likert-type scale ranging from 1 (never) to 7 (always). According to Tracey and Kokotovic, the shortened WAI appears to measure, primarily, a general alliance factor and, secondarily, three specific aspects of the alliance. To clarify these results, Corbiere, Bisson, Lauzon, and Ricard (2006) have recently validated the shortened version of the WAI for people who have experienced severe mental illness and who are registered in an intensive community program for psychiatric patients. The validation results showed that the one-factor solution (12 items) was more robust when the three subscales (i.e., Bond, Task, and Goal) reflected the whole concept of working alliance (Corbiere et al., 2006). For the present study, all scores from the short form of the WAI were considered for evaluating the potential subtle nuances between the Ways of Mattering and the subscales of the WAI.

For both the Ways of Mattering and the WAI, the items were phrased to reflect to the context of this study: the term employment specialist replaced the terms counselor and case manager.

Data Analyses

First, confirmatory factor analyses (CFAs) were carried out on the sample. Using the EQS software (Bentler, 1995) for CFA, we tested four models on all items: (a) four content domains noncorrelated, (b) four content domains correlated, (c) one global dimension, and (d) two-factor solution isolating the respective positively and negatively worded items. Several adjustment indices, such as the chi-square/degrees of freedom ratio, the nonnormed fit index (NNFI), the comparative fit index (CFI), the Bollen incremental fit index (IFI), as well as the root mean square error of approximation (RMSEA), were considered to assess the fit of the models. With respect to the value criterion of these indices, the chi-square/degrees of freedom ratio must be close to two (Byrne, 1989; Hofmann, 1995); the NNFI, CFI, and IFI must be higher than .90; and the RMSEA must be close to .05 for the model to have a good fit (Joreskog & Sorbom, 1993). The maximum likelihood-robust estimation method was used to evaluate all models. Thereafter, the internal consistency of the dimensions extracted from the best model retained from the CFA was computed to verify the conceptual validity of each dimension. Finally, Pearson product-moment correlation coefficients were calculated between all retained dimensions of the Ways of Mattering and the WAI scores to assess the instrument's convergent validity.

Results

Several CFAs were carried out on the 24 items of the Ways of Mattering questionnaire, testing the four previously described models. Only one model, the two-factor solution isolating the respective positively and negatively worded items, fit the empirical data and was the most satisfactory of the four models (see Table 1). However, the fit indices from this model produced borderline coefficients. Using the Lagrange Multiplier Test, we found an error correlation between Items 15 and 19 and 1 item (Item 22) that was poorly saturated (< .30) on its own factor. By adding these error item correlations between Items 15 and 19 ([r.sub.e19e15]) and by removing Item 22, we found that all fit indices fell within the acceptance criteria.

Cronbach's alpha coefficients for the positive and negative dimensions of the Ways of Mattering were .91 and .82, respectively, thus demonstrating satisfactory reliabilities for the two scales (see Table 2).

For the positive and negative dimensions of the Ways of Mattering, the correlation coefficient was .47 (p < .01), indicating a modest relationship between the two factors. The correlation coefficients were higher for the WAI subscales, ranging from .72 to .92 (p < .01). Analysis of the convergent validity between the two concepts showed that all subscales of the WAI were significantly and positively correlated with the positive scale of the Ways of Mattering (r = .64 to r = .80, p < .01), whereas the correlation coefficients were lower for the negative scale (r = .39 to r = .47, p < .01). Furthermore, the Bond subscale of the WAI produced the highest correlation coefficient with the positive dimension of the Ways of Mattering, whereas the negative dimension was most highly correlated with the Goal and Task subscales of the WAI.

Discussion

This study provides initial data on the validity and reliability of the Ways of Mattering questionnaire when answered by people with mental illness and who were registered in supported employment programs. The first objective of this study was to evaluate the dimensions of the Ways of Mattering, using CFAs, for people with mental illness who were seeking a job and who were counseled by an employment specialist. The Ways of Mattering was conceived for people with severe mental illness who were involved in a counseling relationship and not necessarily for a clientele with mental health problems. Consequently, the Ways of Mattering questionnaire was adjusted to this clientele by replacing the term counselor with employment specialist (e.g., "My employment specialist takes my feelings into account"). Initially, the questionnaire was composed of four dimensions, Attention, Importance, Dependence, and Ego-Extension; items on the scales were phrased in positive and negative terms and were equally distributed on each scale. However, the CFA results demonstrated that only the two-factor solution isolating the respective positively and negatively worded items fit the data, regardless of the initial four dimensions. This model represented how people with mental illness felt about their counseling relationship with their employment specialist. Only Item 22, "My employment specialist has accepted few of my suggestions," was problematic because of its ambiguous structure, and it could be transformed as follows: "My employment specialist is not open to accept my suggestions." For future studies, we suggest adding the new version of Item 22 to the Ways of Mattering questionnaire.

These results also indicated that the distinction between a positively phrased item and a negatively phrased item was more important than the distinctions between the four conceptual dimensions of the Ways of Mattering. In a similar study conducted with people experiencing mental illness, it was interesting to note that even though the initial version of the Self-Esteem Rating Scale (Nugent & Thomas, 1993) included one general dimension that assessed several concepts, two main dimensions (positive and negative direction) were found for self-esteem in this group (T. Lecomte, Corbiere, & Laisne, 2006). Two possible interpretations are that (a) people experiencing mental illness put emphasis on the negative and positive dimensions of a general concept rather than on subtle conceptual nuances and (b) people experiencing mental illness assessed the item according to its structure (positive or negative) differently than people who had no such experience.

In this study, we also assessed the convergent validity of the Ways of Mattering with the WAI. As hypothesized, the intercorrelations between the Ways of Mattering and the WAI subscales were significantly positive (r = .39 to r = .80, p < .01), demonstrating the convergent validity of the two instruments. It is also interesting to note that the correlation coefficient of the Bond subscale (emotional dimension) of the WAI was higher for the positive dimension of the Ways of Mattering than it was for the more practical Task and Goal subscales.

Given that working alliance is an important key concept in therapy and rehabilitation (Gehrs & Goering, 1994; Horvath & Symonds, 1991) and that it is recognized as a common factor in psychological interventions, regardless of the theoretical orientation (C. Lecomte & Lecomte, 1999), we can hypothesize that the Ways of Mattering results could be significantly correlated to the same outcomes. Evaluation using the Ways of Mattering could be simply for the counselor's interest (feedback loop) or it could be of broader scope, determining whether process goals were being met as part of a general assessment of the counseling process. More concretely, when a mean score ([less than or equal to] 3) for the negative and positive dimensions, respectively, was indicated during the evaluation, the employment specialist could identify the factors (e.g., the counselor's interpersonal style, the client's self-esteem) that might have hampered the counseling process and determine how these difficulties could be overcome with the client. Furthermore, using the Ways of Mattering would make it possible to understand the underlying mechanisms of the working alliance between the counselor and the client before their relationship is established. Consequently, counselors or other vocational professionals could learn about the impact of mattering in counseling relationships and could pay special attention to their attitudes and behaviors in the counseling process.

The main limitation of this study is the nature of the sample. It would be interesting to validate the Ways of Mattering with other groups of people involved in counseling relationships. The next step in the validation process will be to evaluate the association between the Ways of Mattering results and the client's work outcomes.

In this study, we presented evidence of the factor structure of the Ways of Mattering questionnaire when administered to individuals experiencing mental illness who were registered in vocational programs. The reliability, construct, and convergent validities of this questionnaire were demonstrated using CFA and Cronbach's alpha coefficient and by using the WAI for analyzing the convergent validity. Future research could involve administering the Ways of Mattering to individuals at different times during the counseling relationship to document and analyze changes and to better understand the working alliance foundation and the associated work outcomes.

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APPENDIX

Items of the Ways of Mattering Adapted to Employment Specialists

1. My employment specialist takes my feelings into account.

2. My employment specialist treats me like a number.

3. My employment specialist greets me in a way that makes me feel that I am not important.

4. My employment specialist encourages me to give ideas.

5. My employment specialist has little interest in following my progress.

6. My employment specialist is indifferent to my contributions.

7. My employment specialist supports me in reaching my goals.

8. My employment specialist doesn't listen to what I have to say.

9. My employment specialist helps me feel at ease.

10. My employment specialist doesn't depend on my participation.

11. My employment specialist takes into account what I want to do.

12. My employment specialist notices how I am feeling.

13. My employment specialist relies on my support.

14. My employment specialist cares little about my well-being.

15. My employment specialist isn't interested in hearing about my future plans.

16. My employment specialist believes in me.

17. My employment specialist will continue to be interested in me even when we go our separate ways.

18. My employment specialist doesn't make an effort to make me feel welcome.

19. My employment specialist doesn't appreciate what I have accomplished.

20. My employment specialist follows up to see how I am doing.

21. My employment specialist acknowledges my presence when entering the room.

22. My employment specialist is not open to accept my suggestions. (a)

23. My employment specialist is careful to get my input before making decisions that affect me.

24. My employment specialist has little personal interest in keeping track of me.

(a) This item was revised after considering confirmatory factor analysis results.

Marc Corbiere, Institute of Health Promotion Research, and Norman E. Amundson, Department of Educational and Counselling Psychology, and Special Education, both at the University of British Columbia, Vancouver, British Columbia, Canada. Marc Corbiere is now at Department of Rehabilitation, Universite de Sherbrooke, Longueuil (Quebec) Canada. The authors thank the clients from different supported employment programs implemented in Vancouver, British Columbia, Canada, for kindly taking part in this study. Correspondence concerning this article should be addressed to Marc Corbiere, Department of Rehabilitation, Universite de Sherbrooke, CAPRIT, 1111, St. Charles Ouest #101, Longueuil (Quebec) J4K 5G4, Canada (e-mail: marc.corbiere@usherbrooke.ca). TABLE 1 Results From the Confirmatory Factor Analysis of the Ways of Mattering (N = 196) Model df [chi square] [chi square]/df 1. Four content domains 252 958.3 3.80

noncorrelated 2. Four content domains correlated 246 542.4 2.20 3. One global dimension 252 546.0 2.17 4. Two-factor solution isolating 251 365.0 1.45

the respective positively and

negatively worded items 5. Adjusted two-factor solution 228 302.6 1.45

isolating the respective

positively and negatively worded

items (without Item 22 and error

correlations between Items 15

and 19) Model NNFI CFI IFI RMSEA 1. Four content domains .31 .37 .38 .12

noncorrelated 2. Four content domains correlated .70 .73 .74 .08 3. One global dimension .71 .74 .74 .08 4. Two-factor solution isolating .89 .90 .90 .05

the respective positively and

negatively worded items 5. Adjusted two-factor solution .92 .93 .93 .04

isolating the respective

positively and negatively worded

items (without Item 22 and error

correlations between Items 15

and 19) Note. NNFI = Nonnormed fit index; CFI = comparative fit index; IFI = Bollen incremental fit index; RMSEA = root mean square error of approximation. TABLE 2 Means, Standard Deviations, and Correlations Between the Ways of Mattering and the Working Alliance Inventory Questionnaire and Subscale M SD 1 2 3 4 5 6 Ways of Mattering

1. Positive 4.14 0.67 .91#

2. Negative 4.46 0.58 .47 .82# Working Alliance

Inventory

3. Global 5.50 1.05 .80 .47 .92#

4. Bond 5.64 1.30 .76 .39 .92 .90#

5. Goal 5.34 1.08 .64 .44 .88 .72 .63#

6. Task 5.57 1.13 .74 .44 .93 .80 .73 .89# Note. Global = global score. All correlation coefficients are significant at p < .01. Boldfaced numbers on the diagonal are alpha coefficients. Note: The numbers indicated with # on the diagonal are alpha coefficients.