Relationship of working alliance to mutual and unilateral termination.

Examined the relationship between strength of working alliance after the 3rd session and unilateral client termination. Participants were 4 PhD psychologists and 6 practicum trainees and their 103 college student clients. Both members of 91 counseling dyads (88%) completed the short version of the Working Alliance Inventory (T. J. Tracey and A. M. Kokotovic, 1989) after the 3rd counseling session. Counselor ratings of working alliance were positively associated with mutual termination. Client working alliance ratings did not relate to termination type. It was suggested that counselors focus directly on strengthening weak alliances with clients to prevent client unilateral termination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working alliance in the early phase of counseling.

The relation of the working alliance, as assessed by A. O. Horvath and L. Greenberg's (1986) Working Alliance Inventory (WAI), was examined with respect to (a) a set of client variables (hostility, quality of past and current relationships, level of adjustment, and type of presenting concern) and (b) premature termination status. Ratings on these variables were collected after the first session from 15 counselors rating 144 clients seen at a university counseling center, as well as from 98 of these clients. A canonical analysis of the WAI scales and the client variables revealed that both client and counselor assessments of the alliance were related to the quality of past and current relationships, and level of adjustment as rated by the counselor but not the client. The working alliance was not related to different client presenting concerns. Further, there was no relation between the working alliance and premature termination status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of object relations and security of attachment as predictors of early therapeutic alliance.

Security of attachment and quality of object relations were measured as predictors of initial impressions of the therapeutic alliance as well as dropout. Fifty-five individual psychotherapy clients were administered the Revised Adult Attachment Scale and the Bell Object Relations and Reality Testing Inventory prior to their initial therapy session. Thirty of these participants completed the Working Alliance Inventory following their 1st, 2nd, and 3rd sessions. Security of attachment and quality of object relations were strongly related. Security of attachment and quality of object relations showed relations to early alliance that decreased over time. Attachment and object relations were not related to dropout. Limitations include small sample size and low research compliance rate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of six measures of working alliance.

Compared 6 measures of working alliance: the California Psychotherapy Alliance Scales (CALPAS), the Penn Helping Alliance Scales (PHAS), the Vanderbilt Therapeutic Alliance Scale (VTAS), Working Alliance Inventory—Observer Form (WAI—O), Working Alliance Inventory—Client Form, and Working Alliance Inventory—Therapist Form. All measures had high internal consistency. Observers were able to reach high levels of interrater reliability on all the observer-rated measures (CALPAS, PHAS, VTAS, WAI—O). Evidence of construct validity was found for the CALPAS, VTAS, and WAI—O, given that they were all highly correlated with each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence, childhood sexual abuse history, and social support.

Objective: Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline. Method: At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures. Results: Early alliance was associated with PE adherence (r = .32, p     

Working alliance, attachment memories, and social competencies of women in brief therapy.

Current social competencies and memories of attachment bonds with each parent were examined as they related to influences on formation of the working alliance. Female clients (N?=?76) at 4 university and community agencies completed surveys containing the Parental Bonding Instrument, the Self-Efficacy Scale, the Adult Attachment Scale, and the Working Alliance Inventory. Results indicated that parental bonds, especially with fathers, were significantly associated with social competencies. Multiple regression analyses indicated that social competencies (self-efficacy and adult attachment) accounted for 14% of the variance in client working alliance ratings, whereas recalled parental bonds accounted for 23% of the variance. Working alliance was negatively associated with father bonds, positively associated with mother bonds, and (among social competencies) significantly associated with capacity for adult attachment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Changes in counselor adherence over the course of training.

Following recommendations of S. F. Butler and H. H. Strupp (1993), novice counselors were used to examine the development of adherence and counselor interactional style over the course of manual-based training in time-limited dynamic psychotherapy (TLDP; H. H. Strupp & J. Binder; 1984). Adherence to TLDP was assessed with the Vanderbilt Therapeutic Strategies Scale. Counselor interactional style was assessed with the client version of the Working Alliance Inventory. Growth curve analyses showed a significant linear increase in TLDP adherence and in client-rated working alliance for the novice counselors across 4 supervised training sessions. Time-series analysis (cross-correlations) indicated there was a lead-lag relationship with (a) counseling sessions in which higher ratings of counselor interactional style followed sessions with more counselor adherence to a general psychodynamic interviewing style and (b) sessions with higher ratings on adherence to psychodynamic interviewing style preceded sessions with higher level of adherence to TLDP specific strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session impact, working alliance, and treatment outcome in brief counseling.

Examined associations among working alliance, session evaluations over the course of brief counseling, and counseling outcome. At a training clinic, 61 clients and student counselors from 41 dyads completed ratings of session depth, smoothness, positivity, and arousal after their 1st 12 sessions. Alliance ratings were completed after the 4th session and at termination. Clients and counselors also provided 5 measures of counseling outcome. Results indicated that session evaluations were significantly related to later alliance ratings, and positive alliance ratings predicted subsequent session evaluations. Both linear and curvilinear session effects were suggested. Associations for client ratings were generally stronger than for counselor ratings. Both alliance and session evaluations were significant unique predictors of client-related outcome, but only alliance predicted counselor-rated outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression.

The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' pretreatment counseling expectations as predictors of the working alliance.

Because research suggests that counseling expectations are malleable and that alliance ratings predict clinical outcomes, the relationship between this pretreatment client characteristic (expectations) and the quality of the alliance early in treatment deserves further attention. This study examined the relationships between 57 clients' pretreatment role expectations and 3rd-session client-rated alliance in a naturalistic setting. Prior to intake, clients completed the Expectations About Counseling-Brief Form (H. E. A. Tinsley, 1982), and clients completed the Working Alliance Inventory-Short Form Revised (R. L. Hatcher & J. A. Gillaspy, 2006) following the 3rd therapy session. Results indicate that clients' expectations for personal commitment predicted the task, bond, and goal dimensions of the alliance. Expectations for facilitative conditions and counselor expertise did not predict clients' perceptions of the alliance. Clinical implications and research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between counselors' use of intentions and clients' perception of working alliance.

I examined the relation between counselor intention use and client-rated working alliance. Subjects were 42 volunteer clients paired with 42 counselor trainees for 4 counseling sessions. Ratings were obtained for client interpersonal attitudes, client-rated working alliance, and counselor intention use. Counselor intention use accounted for a moderate amount of variance in client-rated working alliance, after the variance in client interpersonal attitudes was removed. Specific counselor intentions (assessment, explore, support) were negatively related to strength of the working alliance. The implications of these findings for theoretical formulations of working alliance formation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Videoconferencing-based family counseling for rural teenagers with epilepsy: Phase 1 findings.

Objective: Assess the effects of videoconferencing-based counseling on the psychosocial functioning of rural teenagers with epilepsy. Setting: University and rural communities. Participants: Twenty-two teenagers with epilepsy and their parents. Interventions: Six sessions of home-based video counseling, home-based speakerphone counseling, or office-based counseling. Main Outcome Measures: Problem severity and frequency, Social Skills Rating System, modified Working Alliance Inventory, and treatment adherence. Results: Teenagers and parents reported significant reductions in both problem severity and frequency across all 3 conditions from pre- to post-6th session to the 6-month follow-up. Parents reported significant increases in prosocial behaviors from pre- to post-6th session to follow-up. In contrast, both parents and teachers reported no change in problem behaviors over time. No differences in adherence were found across the 3 modalities. Overall therapeutic alliance was high but varied as a function of family member and treatment. Conclusions: Mode of delivery did not influence initial treatment outcomes or adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring the working alliance in advisor–advisee relationships in graduate school.

Drawing from the working alliance literature, the authors constructed the Advisory Working Alliance Inventory (AWAI) to measure the graduate advising relationship from the student's perspective. Two hundred eighty-one counseling psychology doctoral students participated in the 1st study (79% response rate). Three factors (Rapport, Apprenticeship, and Identification-Individuation) were extracted by factor analysis. The AWAI showed very good internal consistency reliability. Scale validity was supported by positive correlations between the AWAI and measures of advisee research self-efficacy and attitudes toward research, as well as the perceived expertness, attractiveness, and trustworthiness of the advisor. Forty-one students participated in the 2nd study, in which the AWAI demonstrated excellent test-retest reliability over a 2-week interval. Implications of the advising working alliance are discussed for doctoral training and areas for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A time series model of the working alliance: A key process in short-term psychoanalytic counseling.

The relationship between the counselor and client's perception of the working alliance across sessions was investigated in short-term psychoanalytic counseling. Prior research suggests that counselors play a large role in clients' perception of the working alliance. A time-series analysis allowed specific processes based upon prior research and theory to be tested. The results illustrate a time-bound process of counselor and client perceptions of the working alliance. The findings provide further evidence that counselors play a major role in clients' perception of the working alliance and that this impact carries over into the subsequent sessions in short-term psychoanalytic counseling. Implications are discussed and avenues for future research are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient pretreatment interpersonal problems and therapeutic alliance in short-term cognitive therapy.

The growing consensus regarding the importance of interpersonal process in psychotherapy, as well as of interpersonal factors in self-definition, has underscored the relevance of examining patient interpersonal functioning as it relates to the development of the therapeutic alliance. This study examined the relationship of patient pretreatment interpersonal functioning, as measured by the Inventory of Interpersonal Problems and the Millon Clinical Multiaxial Inventory (MCMI), to the therapeutic alliance, as measured early in treatment by a patient self-report version of the Working Alliance Inventory. On the basis of an interpersonal circumplex interpretation, the results generally indicated that friendly-submissive interpersonal problems were positively related to the development of aspects of the alliance and that hostile-dominant problems were negatively related to the development of aspects of the alliance early in short-term cognitive therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Missouri Psychoanalytic Counseling Research Project: Relation of changes in counseling process to client outcomes.

A short-term psychoanalytic counseling model was used to identify process dimensions and client outcomes. Six counselors saw 16 clients over the course of 2 semesters. Clients responded to measures at pre- and posttest and after each session, and counselors filled out measures following each session. Sessions were audio- and videotaped and viewed by trained raters. P-technique factor analysis identified 4 dimensions: Psychoanalytic Technique, Working Alliance, Client Resistance, and Client Transference. Results of hierarchical linear modeling indicated that counselor use of psychoanalytic technique and the working alliance increased steadily across the sessions, whereas client resistance steadily decreased. The alliance dimension also changed in a quadratic fashion. The process dimensions also influenced each other and were related to better client outcomes. Implications are discussed and suggestions for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining counselor interventions and client progress in the context of the therapeutic alliance.

Counselor and client statements from 21 sessions with counselors were used to examine the relationship of counselor response modes to categories of client good moments at different alliance levels. The Working Alliance Inventory, Hill Counselor Verbal Response Category System-Revised, and the Category System of Client good moments were used to categorize moments of in-session progress. Loglinear modeling procedures indicate that the alliance was present in all best-fitting models of the data. Exploratory examination of the models revealed that client good moments did not necessarily increase in frequency as the alliance increased. Further, different categories of interventions were associated with client good moments of provision of significant information at different alliance levels. These findings suggest that qualitatively different therapeutic processes are in operation at different alliance levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations of complementarity and supervisory issues to supervisory working alliance: A comparative analysis of two cases.

This study examined the effects of complementary communications and supervisory issues on the formation of working alliance in 2 graduate student supervisor–supervisee dyads, 1 characterized by high alliance and 1 by low alliance, over the first 3 weeks of clinical supervision. A research-informed case study method was used to collect process and outcome data from the participant and rater perspectives. Results provided some support for (a) a sequential order of the themes or issues underlying the professional development of counselor trainees, (b) a higher degree of complementary interaction in the high-alliance dyad than in the low-alliance dyad, and (c) a relation between complementarity and supervision satisfaction level. Implications for future research and practice are discussed relative to the supervision literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using client feedback in psychotherapy training: An analysis of its influence on supervision and counselor self-efficacy.

Tracking client outcome and the therapeutic relationship across treatment (i.e., client feedback) has become a recommended practice for clinicians. This study investigated whether the utility of this practice would extend to trainees if the data gained from clients was provided to their supervisor for use within supervision. Trainees (N = 28) were assigned to a continuous feedback condition or no-feedback condition for 1 academic year. Results indicated that trainees in both conditions demonstrated better client outcomes at the end of their practicum training than at the beginning, but those in the feedback condition improved more. However, those in the feedback condition did not rate the supervisory alliance or satisfaction with the supervision process differently. The relationship between counselor self-efficacy and outcome was stronger for trainees in the feedback condition than for those in the no-feedback condition, perhaps indicating that feedback may facilitate a more accurate assessment of one’s skills. Implications of how counseling self-efficacy, the supervisory alliance, and satisfaction with supervision are related to effective supervision are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)