Patients' and therapists' shared and unique views of the therapeutic alliance: An investigation using confirmatory factor analysis in a nested design.

Analyzed large general factor found in measures of the therapeutic alliance by use of confirmatory factor analysis (CFA) in a nested design. Ratings by 38 therapists and their 144 patients on the California Psychotherapy Alliance Scales (CALPAS), the Revised Penn Helping Alliance Questionnaire (HAQ-R), and the Working Alliance Inventory (WAI) were adjusted for therapist effects. A set of models for S and therapist ratings was tested with CFA, and a 3-factor model was confirmed, x–2(4)?=? 7.19, p> .13; GFI?=?.98; RMSR?=?.02; CFI?=?1.0. A shared-view factor (best represented by HAQ-R) accounted for 44% of patients' and 27% of therapists' variance. Unique factors accounted for 56% of therapists' and 43% of Ss' variance. S views split between HAQ and WAI factors; The WAI factor was most expressive of therapist views. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the Working Alliance Inventory.

The Working Alliance Inventory (WAI; A. O. Horvath and L. S. Greenberg [see PA, Vol 76:24600]) was completed after the 1st psychotherapy session by 84 university counseling center clients and 15 therapists rating their work with 123 clients. The factor structure of these responses was examined using confirmatory factor analysis. A model with 1 general factor, a model with 3 specific factors, and a bilevel model of the factor structure were examined. The bilevel factor structure, with a General Alliance factor as its primary factor and 3 secondary specific factors, fit the data best. The items most indicative of the 3 specific factors were selected to form a 12-item short form of the WAI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and validation of the Working Alliance Inventory.

Present stages of development and preliminary validation of a self-report instrument for measuring the quality of alliance, the Working Alliance Inventory (WAI). The measure is based on Bordin's (1980) pantheoretical, tripartite (bonds, goals, and tasks) conceptualizaton of the alliance. Results from 3 studies were used to investigate the instrument's reliability and validity and the relations among the WAI scales. Data suggest that the WAI has adequate reliability. The instrument is reliably correlated with a variety of counselor and client self-reported outcome measures. Nontrivial relations were also observed between the WAI and other relationship indicators. Results are interpreted as preliminary support for the validity of the instrument. Although the results obtained in the reviewed studies are encouraging, the high correlations between the 3 subscales of the inventory bring into question the distinctness of the alliance components. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client Attachment to Therapist, Depth of In-Session Exploration, and Object Relations in Brief Psychotherapy.

Two studies explored attachment in psychotherapy. In the 1st study, clients (N=38) in time-limited therapy completed the Experiences in Close Relationships Scale as a measure of adult attachment, the Client Attachment to Therapist Scale (CATS), Working Alliance Inventory (WAI), and measures of session depth and smoothness. Consistent with J. Bowlby's (1988) concept of a secure base promoting greater exploration, secure attachment to therapist was significantly associated with greater session depth and smoothness. Insecure adult attachment was associated with insecure therapeutic attachment. CATS subscales predicted unique variance in session experience not accounted for by the WAI alone. The 2nd study was a new analysis of data originally reported by B. Mallinckrodt, D. L. Gantt, and H. M. Coble (1995). Among women clients (N=44) who completed the CATS, WAI, and the Bell Object Relations and Reality Testing Inventory, 2 CATS subscales predicted unique variance in object relations deficits not accounted for by the WAI alone. (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)     

Convergent validy of the Agnew Relationship Measure and the Working Alliance Inventory.

The convergent validity of the Agnew Relationship Measure (ARM) and the Working Alliance Inventory (WAI) was assessed in samples drawn from 2 comparative clinical trials of time-limited psychotherapies for depression. In 1 sample, clients (n=18) and therapists (n=4) completed self-report versions of both measures after every session (n=198). In the other sample, clients (n=39) and therapists (n=6) completed the ARM, and observers subsequently rated selected audiotaped sessions (n=78) using the WAI. In both samples, the ARM's core alliance scales (Bond, Partnership, and Confidence) were correlated with the WAI's scales (Bond, Tasks, and Goals) strongly when assessed within client and therapist perspectives and, with some qualifications, moderately when assessed between client, therapist, and observer perspectives, supporting the assumption that the ARM and the WAI measure some of the same core constructs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Focus on therapeutic alliance: The psychometric properties of six measures across three treatments.

The psychometric properties of six measures of therapeutic alliance (California Psychotherapy Alliance Scales; Penn Helping Alliance Rating Scale; Vanderbilt Therapeutic Alliance Scale; and the Working Alliance Inventory- therapist, client, and rater versions) were compared in a sample of 60 substance-dependent individuals participating in a randomized clinical trial of three psychotherapies. Internal consistency, interrater reliability, and intercorrelations among the instruments were evaluated. Results supported the construct validity of the therapeutic alliance and indicated that all six measures had acceptable reliabilities. Correlations between observer and participant measures were comparatively low. Reliabilities did vary, however, by treatment condition, suggesting that psychometric properties, and by extension alliance-process-outcome relationships, may vary across treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the alliance using the Psychotherapy Process Q-Set.

The alliance between therapist and patient was investigated using the Psychotherapy Process Q-Set (PQS), an instrument that quantitatively describes therapy sessions in a manner that captures the complexity of the therapy process. More specifically, the PQS was used to examine the treatment processes being assessed by observer ratings on the California Psychotherapy Alliance Scales (CALPAS). Using data from 30 brief psychodynamic psychotherapy treatments (patients aged 20–81 yrs), three PQS factors were found to be associated with alliance: Patient–Therapist Interaction, Patient Capacity/Commitment, and Therapist Countertransference. In multiple regression analyses with scales constructed from these three factors, Patient–Therapist Interaction was found to predict alliance ratings, while the other two aspects of the treatment process did not account for any significant additional variance in the alliance ratings. Results suggest that Patient–Therapist Interaction plays a defining role in the alliance construct, as assessed by the observer version of the CALPAS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two aspects of the therapeutic alliance: Differential relations with depressive symptom change.

Objective: The therapeutic alliance has been linked to symptom change in numerous investigations. Although the alliance is commonly conceptualized as a multidimensional construct, few studies have examined its components separately. The current study explored which components of the alliance are most highly associated with depressive symptom change in cognitive therapy (CT). Method: Data were drawn from 2 published randomized, controlled clinical trials of CT for major depressive disorder (n = 105, mean age = 40 years, female = 62%, White = 82%). We examined the relations of 2 factor-analytically derived components of the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) with symptom change on the Beck Depression Inventory—II (BDI–II; Beck, Steer, & Brown, 1996) that occurred either prior to or subsequent to the examined sessions. WAI ratings were obtained at an early and a late session for each therapist–patient dyad. Results: Variation in symptom change subsequent to the early session was significantly related to the WAI factor that assesses therapist–patient agreement on the goals and tasks of therapy but not to a factor assessing the affective bond between therapist and patient. In contrast, both factors, when assessed in a late session, were significantly predicted by prior symptom change. Conclusions: These findings may reflect the importance, in CT, of therapist–patient agreement on the goals and tasks of therapy. In contrast, the bond between therapist and patient may be more of a consequence than a cause of symptom change in CT. The implications of these results and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relevance of the supervisory alliance to the counseling alliance and to treatment adherence in counselor training.

The quality of the supervisory working alliance should be related to the quality of the counseling working alliance and to trainee adherence to a treatment model. After each of 4 supervision sessions, 75 trainees completed the Supervisory Working Alliance Inventory, and, after each counseling session, their clients completed the Working Alliance Inventory. Judges rated portions of the videotaped counseling sessions with an adherence measure. Hierarchical linear modeling was used to analyze these nested data (repeated measures of trainees nested within supervisors). As hypothesized, the trainee's perception of the supervisory alliance was significantly related to the client's perception of the counseling alliance and to aspects of treatment adherence. The significance of these findings is discussed in relation to the supervision literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Level of psychosocial development, perceived level of psychological difficulty, counseling readiness, and expectations about counseling: Examination of group differences.

Multivariate analyses of variance and multiple regression analyses were performed to examine the relation between students' expectations about counseling and three measures of students' psychosocial development. A sample of 172 undergraduate college students completed the Expectations About Counseling Questionnaire—Brief Form (EAC—B) and the Developing Purpose scale of the Student Developmental Task Inventory (2nd edition; SDTI—2), the Counseling Readiness Scale (CRS) of the Adjective Check List, and the Career Counseling Diagnostic Inventory (CCDI). Significant relations between students' expectations about counseling and their scores on the SDTI—2 were found after the variance in expectations attributable to gender, age, and year in school had been extracted. No significant relations were found between scores on the EAC—B and scores on the CRS or CCDI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A validity study of two projective object representations measures.

Two projective measures of object representations, the Concept of the Object on the Rorschach (H. Rorchach, 1942) and the Social Cognition and Object Relations Scales (D. Westen, 1993) were compared with each other, with measures of intelligence (Wechsler Adult Intelligence Scale—Revised; D. Wechsler, 1981), and measures of pathology (Millon Clinical Multiaxial Inventory [T. Millon, 1983], Minnesota Multiphasic Personality Inventory [S. R. Hathaway & J. McKinley, 1983] Axis 11 diagnoses). Analyses focused on the construct validity of object representations and the implications of structural and affective aspects of object representations for psychopathology. Results support the construct validity of object representations and an affective, but not a cognitive–structural, linkage between object representations and pathology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clients’ secret keeping and the working alliance in adult outpatient therapy.

This research investigated the relations among clients’ keeping relevant secrets in therapy, the working alliance, and symptom change. Clients (N = 83) in outpatient therapy and their therapists (N = 22) at a mental health hospital completed confidential surveys after a session of ongoing therapy. The clients who reported keeping a relevant secret (27.7%) scored significantly lower on the Working Alliance Inventory (WAI) than did clients who said that they were not, even when the analyses controlled for clients’ social desirability scores and for therapist effects. Therapists of these clients also reported a weaker working alliance, even though the therapists typically did not know that the clients were keeping a relevant secret. However, keeping a relevant secret was not related to symptom change. The findings support the long-standing belief that secret keeping in therapy either hurts the therapeutic relationship or happens when the relationship is relatively weak. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, general distress, and causal attributions among university students.

Attempted to replicate I. H. Gotlib's (see record 1984-15153-001) finding of a high intercorrelation among various measures of distress (depression, state anxiety, trait anxiety, psychosomatic complaints, and assertiveness) within an undergraduate sample. Results obtained from 134 undergraduates found the Beck Depression Inventory to be highly correlated with the State-Trait Anxiety Inventory—Form Y, the Rathus Assertiveness Schedule, and the Psychosomatic Symptom Checklist, although the assertiveness measure demonstrated some discriminant validity according to a principal-components analysis. A canonical correlation analysis revealed that all 5 measures of distress were significantly related to causal attributions concerning both positive and negative events on the Attributional Style Questionnaire, partially replicating Gotlib's results. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client attachment to therapist: Relation to client personality and symptomatology, and their contributions to the therapeutic alliance.

This study examined the relation of client attachment to the therapist to diverse facets of the therapeutic alliance, client personality, and psychopathological symptoms, as well as the relative importance of therapeutic attachments, personality, and symptomatology in predicting the alliance. Eighty clients in ongoing therapy completed measures of client attachment to therapist (CATS), personality (6FPQ), psychopathological symptoms (BSI), and therapeutic alliance (WAI–Short, CALPAS, HAQ). Secure and Avoidant–Fearful attachment to the therapist correlated positively and negatively, respectively, with total and subscale alliance scores. Preoccupied-Merger therapeutic attachment was unrelated to the alliance. Exploratory analyses suggested however that the relationship between Preoccupied–Merger attachment and the alliance was moderated by the extent to which clients were distressed. Clients' therapeutic attachments were unrelated to basic personality dimensions. Preoccupied–Merger attachment to the therapist correlated significantly with several symptom dimensions. Clients' therapeutic attachments emerged as superior and more consistent predictors, relative to client personality and symptomatology, of the therapeutic alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional predisposition to psychotropic drug effects

Administered a battery of psychological tests (Comrey Personality Scales, State-Trait Anxiety Inventory, Mood Questionnaire, and Health Status Inventory) to 107 female adults 3 hrs prior to surgery under ketamine anesthesia. Results show that moods were more highly related to the psychotropic effects of ketamine than any of the other measures. Some form of counseling intervention that would better prepare patients to cope with the surgical situation might be effective in reducing this emotionality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and general psychopathology in university students.

Examined the relationship between self-reported depression and a number of self-report measures of other forms of maladaptive functioning in a subclinical population. Seven questionnaires, including the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory—Form Y, completed by 443 undergraduates yielded 17 different pathology scales. All of the scales were significantly intercorrelated. Furthermore, a factor analysis yielded a 2-factor solution with the 1st factor, composed of all but 3 scales, accounting for 50% of the total variance. Chi-square analyses revealed that only 5–20% of the Ss were cross classified as high on one measure and low on another. Results are discussed with reference to the ability of self-report measures to differentiate discrete forms of psychopathology in both subclinical and psychiatric populations. It is concluded that caution is needed in extrapolating findings from studies with students scoring high on the BDI. (85 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)