Thirty-eight traumatic brain injury (TBI) patients who underwent a neuropsychologically oriented milieu rehabilitation program were compared with an historical control group of 38 TBI patients who did not receive this form of rehabilitation. Patients were matched according to admitting Glasgow Coma Scale (GCS) score, age at injury, and gender. Educational level and chronicity of brain injury were not completely matched but were controlled for in statistical analyses. A greater number of TBI patients who received this form of rehabilitation were productive (ie, a student, a worker, or both) compared with the untreated group. A good or excellent working alliance with the rehabilitation staff was significantly related to a positive productivity status. The same finding was observed when assessing the relationship of the working alliance with the patients' families and productivity status. The data support the proposition that specialty neurorehabilitation programs aimed at work reentry may be helpful in a selected group of TBI patients.