Objective
This study analyses the psychometric properties of the Working Alliance Inventory adapted for guided Internet interventions (WAI‐I).
Methods
We drew on the data set from a multicenter trial ...that examined a guided Internet intervention (deprexis) for patients with mild to moderate depression. Two hundred twenty‐three patients completed the WAI‐I and the Patient Satisfaction Questionnaire (ZUF‐8) at posttreatment, and the Attitudes toward Psychological Online‐Interventions Questionnaire (APOI) at baseline. We ran confirmatory factor analyses (CFA) testing two‐ and three‐factor solutions and calculated Cronbach's α, item‐total correlations, and correlations of the WAI‐I with APOI and ZUF‐8.
Results
The results suggested a two‐factor solution, with a very good model fit and evidence of factor independency, adequate internal consistency, and external validity for the complete scale and the sub‐scales.
Conclusions
The WAI‐I showed as a reliable and valid instrument to capture alliance in guided Internet interventions, which might facilitate process‐outcome research and treatment development efforts.
Working alliance theory describes the therapist–client relationship in psychotherapy and has been adapted to study workplace coaching effectiveness. The application of this theory in workplace ...coaching research has produced mixed results suggesting that additional factors could be at play. In workplace coaching, the organization often pays for and influences the coaching process. The role of the organization in the working alliance between coach and coachee has, however, not been studied sufficiently. his exploratory, hybrid deductive–inductive qualitative study used the Working Alliance Inventory as theoretical lens to examine coachees’ perspectives on the organizational role in the coach–coachee working alliance. The findings indicate that organizations have a direct impact on the bond, task, and goals of the working alliance by facilitating the coaching process, influencing the coaching agenda and contract, and through coach selection. This tentative analysis suggests that measurements of the working alliance should be extended to include these organizational aspects.
The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also ...conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals .256, .299, p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.
Clinical Impact Statement
Question: How robust is the correlation of the alliance (as a holistic, collaborative quality measured during therapy) with therapy outcomes? Findings: Based on over 300 studies, the positive relation of the alliance and outcome remains across assessor perspectives, alliance and outcome measures, treatment approaches, patient (intake-) characteristics, face-to-face and Internet-mediated therapies, and countries. Meaning: The alliance, which is of a mutual collaboration and partnership between therapist and client, is an important aspect of psychotherapy across various psychotherapy approaches. Next Steps: The universality of the alliance-outcome relation and the potential conceptual boundaries have to be investigated across cultural and biopsychosocial contexts inside but also outside of psychotherapeutic settings in a quantitative and in a qualitative manner.
The quality of the therapeutic alliance between a client and their clinician is thought to play an important role in healthcare but there is limited research about this concept in stroke ...rehabilitation. This study explored the core components of a therapeutic alliance and the factors perceived to impact on its development in a stroke rehabilitation unit.
Interpretive description methodology was used to gather and synthesise participants' experiences of their therapeutic relationships. Ten individual client interviews and one clinician focus group were conducted. Data was were analysed using conventional content analysis.
A therapeutic alliance appeared to consist of three overlapping core components: a personal connection, a professional collaboration, and family collaboration. Clients valued these components to different degrees and priorities could change over time. Alliance breakdowns were perceived to stem from a clinician's incorrect assumptions about their client's relationship preferences or lack of responsiveness to their needs. Recovery of the alliance seemed to depend on the strength of the pre-existing relationship and steps taken to repair it.
Establishing and maintaining a therapeutic alliance appears to be an individualised and complex process. A clinician's ability to use their personal attributes therapeutically, and professional skills flexibly, appeared integral to relationship quality.
IMPLICATIONS FOR REHABILITATION
Developing therapeutic relationships requires a person-centred and sometimes family/whānau-centred approach.
The judicious use of self-disclosure may achieve emotional proximity and yet maintain professional boundaries.
Maintaining relationship health requires a proactive approach to detect and manage relationship disruptions.
Introduction Extensive research has explored the incorporation of humor in therapy, revealing its potential positive effects on clients’ mental well-being and personal growth. However, limited ...research exists on how coaching could benefit from humor as an intervention and how its utilization impacts the interaction processes and outcomes for both the coachee and coach. Therefore, our research focuses on the use and effects of spontaneous humor within professional dialogues. This paper aims to extract insights from academic literature on humor in adjacent fields and apply these insights to the context of coaching. Methods This paper offers implications for coaching theory and practice, alongside a proposed research agenda. The initial phase involves analyzing reviews on humor in professional contexts, and coaching. Secondly, following the PRISMA guidelines for review, we identified 13 empirical studies, which address the role of humor in counseling, psychotherapy, and mentoring. Results and discussion Our findings suggest that humor serves as a valuable tool for establishing and deepening the working alliance, fostering adaptive coping mechanisms in clients, and enhancing the cognitive and behavioral process. Moreover, humor is shown to be advantageous for professionals in navigating challenging client relationships. These findings hold significance for the realm of coaching practice as well. In light of these insights, we propose the integration of humor use in education toolkits for coaching professionals.
Videoconferencing psychotherapy (VCP)—the remote delivery of psychotherapy via secure video link—is an innovative way of delivering psychotherapy, which has the potential to overcome many of the ...regularly cited barriers to accessing psychological treatment. However, some debate exists as to whether an adequate working alliance can be formed between therapist and client, when therapy is delivered through such a medium. The presented article is a systematic literature review and two meta‐analyses aimed at answering the questions: Is working alliance actually poorer in VCP? And is outcome equivalence possible between VCP and face‐to‐face delivery? Twelve studies were identified which met inclusion/exclusion criteria, all of which demonstrated good working alliance and outcome for VCP. Meta‐analyses showed that working alliance in VCP was inferior to face‐to‐face delivery (standardized mean difference SMD = −0.30; 95% confidence interval CI −0.67, 0.07, p = 0.11; with the lower bound of the CI extending beyond the noninferiority margin −0.50), but that target symptom reduction was noninferior (SMD = −0.03; 95% CI −0.45, 0.40, p = 0.90; CI within the noninferiority margin 0.50). These results are discussed and directions for future research recommended.
This review investigated whether ceiling effects on client-reported working alliance measures represent measurement artifacts or valid information related to the formation of the working alliance. ...Using data from two previously published meta-analyses, a total of 92 estimates of ceiling effects were calculated based on 37 studies with 6,439 participants. Analyses examined the size of ceiling effects, relation with demographic variables, type of alliance measure, and ceiling effect stability across sessions. Moderate to large ceiling effects appeared across score distributions of multiple measures of client-rated alliance, across time administered, and across different sample characteristics such as gender, age, and ethnicity. When examined with the Session Rating Scale (SRS), analyses indicated ceiling effects had a moderate correlation with session number. When SRS ceiling effects were examined in a single study with a large sample of complete cases (N = 2,990) across seven sessions, large initial ceiling effects continued to increase slightly in size across sessions. Higher ceiling effects were also observed with the Working Alliance Inventory. Given the prevalence and relative stability of ceiling effects on score distributions, working alliance scores do not exhibit the characteristics of a normally distributed continuous variable. While the working alliance has typically been defined in terms of theoretical content such as tasks, goals, and bond, study findings suggest another key element may be a threshold structure where clients shift to an experience of the therapeutic relationship as established. Discussion focuses on directions for alliance research and clinical practice as well as study limitations.
Public Significance Statement
This review found evidence of widespread ceiling effects on measures of the working alliance, suggesting that the alliance typically develops early in psychotherapy. Findings can inform the development of new theory about the early therapy environment as well as new methods to assess the alliance.
This study investigated the relationships between the supervisory working alliance and supervision outcome variables using meta‐analysis. The authors reviewed 27 articles, dissertations, and theses ...published between 1990 and 2018. The authors used the MIX program to calculate the meta‐analyses. The results indicate that the supervisory working alliance is positively related to supervision outcome variables. Supervisees’ perceived relationship with the supervisor was positively related to the relationship with the client. This shows that the phenomenon of isomorphism is a repeated pattern in the relationships in supervision and counseling. The authors discuss the limitations and implications.
Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better ...alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge.
What is the public health significance of this article?
Improvements in the quality of the patient-rated alliance are associated with subsequent symptom reduction early in psychotherapy, and symptom reduction is associated with further improvement in the subsequent alliance. This meta-analysis provides empirical evidence for good clinical wisdom that collaborative qualities within the therapist-patient relationship and early distress remediation go "hand-in-hand." These results underscore the relevance of respectful, collaborative, and ethically sound care for mental health patients to positively impact therapy outcomes.
Several theorists (Bandura, 1969; Hackney & Goodyear, 1984; Searles, 1955) suggest parallels between the relationship in supervision and the relationship in therapy. We examined supervisor and ...therapist trainee ratings of supervisory working alliance (SWA) in 1 week predicting client-rated therapeutic working alliance (TWA) and client-rated therapy session evaluation (TSE) in the following week as well as TWA and TSE ratings in 1 week predicting SWA ratings in the following week. Our data included 663 weeks of therapy nested within 28 trainees nested within 15 supervisors, disaggregated into differences between supervisors, differences within supervisors, and differences within trainees. At the between-supervisor level, when supervisors' trainees rated the SWA higher on average compared with other supervisors' trainees' average SWA ratings, their clients' average TWA rating was higher. In contrast, when supervisors rated the SWA higher on average compared with other supervisors' average SWA ratings, their trainees' clients' average TSE rating was higher but the average TWA rating was lower. At the within-supervisor level, when trainees rated a higher SWA on average compared with other trainees' average SWA ratings with the same supervisor, their clients' average TSE rating was higher. The theoretical prediction of parallel relationships in supervision and therapy was supported, but only for between-supervisor and within-supervisor differences in SWA. We found no evidence that week-to-week changes in SWA or client-rated TWA or TSE reflected parallel relationships. We provide suggestions for further research, including exploring the mechanisms through which supervision relates to the therapy process and outcome.
Public Significance Statement
This study provides preliminary evidence for the link between supervision and the psychotherapy process and outcome. In general, our results suggest that some supervisors form stronger alliances with their trainees, and the clients of those trainees report stronger alliances and better session quality. Hence, some supervisors are more effective than others at developing alliances with their supervisees, and this effectiveness is linked to a better client-perceived therapy process and outcome.
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