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 persons with severe and persistent mental illness should be integrated. Unclear in this model is what role psychotherapy could play. In particular, it is unknown whether psychotherapy can make a unique contribution and whether there are issues it might systematically address in the context of vocational rehabilitation. To examine these questions we report on the psychotherapy of six consumers enrolled in supported employment, a prominent form of vocational rehabilitation. Using these cases as illustrations, we suggest that in an integrative team approach, psychotherapy can facilitate vocational rehabilitation 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 consumers were allowed to reframe old ideas, question inconsistencies, and keep track of the structure and content of revised narrative until fully integrated into memory. Despite a wide range of severe impairments, this process enabled consumers to incorporate work into a now more complete and coherent life narrative. Implications for practice and research are discussed.