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At least 19 recordsLinked to original sources
PubMed2003

Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form.

Working Alliance Inventory (WAI) ratings were compared with ratings comprising the 12-item WAI, Short Form (WAI-S). Responses were collected from 54 university counseling center client-therapist pairs after the 4th therapy session as well as at a final ratings point. WAI and WAI-S scores were highly correlated and had comparable descriptive statistics, internal consistencies, and subscale intercorrelations within and across rater perspectives. Predictive validity estimates for WAI and WAI-S total scales were also very similar. Fourth-session WAI and WAI-S scores were moderately predictive of therapy improvement ratings. Results support the interchangeability of scores on the WAI and WAI-S scales.

Counseling↗
PubMed1992

[The working alliance is St. Stephan's cathedral. Epistemological considerations of the Heinrich Deserno lecture, "Analysis and the working alliance" (1990)].

With the term "working alliance", as it was discussed by R.R. Greenson in noted publications, an understanding of work was introduced that corresponds with the dominant contemporary idea of work as a purely instrumental and technical process which is alien to the original "spirit" of Freudian Analysis. The author shows that psychological work, which in analysis is carried out cooperatively by analyst and analysand, needs transference to be successful, a transference with the help of which the analysand is able to discuss and specify his unconscious psychological conflicts. In Greenson's understanding the working alliance--supposedly neurosis-free--appeals to the rational part of the ego and introduces a normative understanding of reality. The transference relationship, by contrast, gives room to those psychic forces which refuse to obey the authority of the ego and its tendencies to conventionalize and suppress unconscious material.

Humans↗
PubMed2000

The therapeutic and working alliances.

Since their introduction, the concepts of the therapeutic alliance and the working alliance have provoked debate regarding the nature and function of these alliances and the applicability and validity of the concepts. Features of these concepts as originally put forth by Zetzel and Greenson, respectively, are delineated, with emphasis on the significant distinctions between them. Their relation to degree of psychopathology is examined, especially with respect to what may be understood as the more "silent" aspects of the therapeutic alliance. Mutual identification, empathy, and role-responsiveness are stressed as constituent features of the therapeutic alliance, with the working alliance seen as possible (theoretically and clinically) only after a therapeutic alliance has to some degree been established. Both alliances are understood as intrinsic structures within the analytic process, and illustrative case material is presented.

Adult↗
PubMedDate not supplied

Quality of early working alliance in psychotherapy: diagnoses, relationship and intrapsychic variables as predictors.

BACKGROUND: The aim of the study was the prediction of the quality of early working alliance, using possible predictors among patient pretreatment variables: diagnoses, current and past relationships and intrapsychic ones. Data are from the ongoing, naturalistic Norwegian Multisite Project on Process and Outcome of Psychotherapy (NMSPOP). METHODS: The sample, n = 270, is recruited from 15 outpatient clinics; 61.1% of the patients have personality disorders. Alliance was assessed with the Working Alliance Inventory (WAI), and predictors include independent clinicians' evaluations of diagnostic/interpersonal/intrapsychic characteristics and the patients' self-reports on similar and additional variables. RESULTS: Four of 6 hypotheses were supported: Quality of working alliance is difficult to predict, early alliance is better predicted than later, diagnostic variables do not predict quality of working alliance, but quality of both current and past relationships is associated with working alliance. In a hierarchical multiple-regression analysis, 7% variance of working alliance in the 3rd session was explained from current relationship variables, whereas alliance in the 12th session was not predicted by the same model. Intrapsychic variables predicted the therapists' ratings of alliance, but not the patients' ratings. CONCLUSION: The results are in line with previous research, and also with the theoretical model for working alliance.

Adult↗
PubMed1992

Voice of a hidden minority: identification and countertransference in the cross-cultural working alliance.

This paper has expanded the psychoanalytical definition of the working alliance to include the influence of culture. The cross-cultural working alliance is a therapeutic dyad that incorporates a psychotherapist and a patient of dissimilar backgrounds. Each participant enters the alliance with cultural introjects--values, attitudes, and ways of behaving that stem from ethnocultural roots. These introjects influence the intrapsychic world, shape the conscious worldview, and the perception of life experience. The influence of cultural predispositions on the psychopathologies of the patients was prominent in two case examples: a black West Indian male and a Korean-American male. The therapist also brought cultural predispositions to her work. A constructive countertransference phenomenon occurred in the working alliance that had a direct connection to its cross-cultural nature. This phenomenon is called associative identification--the conscious identification of therapist with the ego experience of patient. With the use of the associative identification, the therapist uncovered parallel memories that promoted theoretical understanding and informed therapeutic technique. Just as anthropologists claim that cultures share universal institutional patterns, it is proposed that universal cultural conflicts may also be observed in the cross-cultural working alliance. The analyst and patients in this study had two culture-conflicts in common: the longing to be seen, and the pull for disidentification. It is concluded that associative identification enriched the reparative quality of treatment, and encouraged the integration of isolated, split-off parts of the self.

Adult↗
PubMed1993

[The prognostic significance of the therapeutic working alliance from the perspective of the patient and therapist].

In general, the prognostic relevance of a working alliance for both the course and the outcome of psychotherapy is no longer a matter of dispute. Since a working alliance is conceived as an interactional variable, the results must be interpreted on the basis of several important dimensions: the perspective of the investigator and the time structure during the course of therapy. Using the data available from the Berlin Psychotherapy Study (Rudolf 1991), we investigated for the 238 patients (inpatients and outpatients who received psychoanalytically oriented therapy in the study) the prognostic relevance of diagnostic and therapy-related working alliance variables for the various outcomes investigated. A complex correlation-statistical method (latent-trait-model) was used to consider the investigator perspective with regard to the working alliance and the outcome as well as the time structure and the diagnostic variables. Our results emphasize the relevance of the therapist's perspective beginning with the diagnostic indication, the working alliance and finally the outcome. The patient's perspective, however, seems to be less relevant. The results are presented and discussed in relation to the relevant literature. One result we have found as a further important dimension is that the kind of therapy carried out must be taken into consideration. This implies that as in our study for all phases of the investigation therapy specific instruments must be applied. In this regard our results also contribute to the validation of the instrument used to measure the working alliance TAB.

Adult↗
PubMed1975

The therapeutic and working alliances.

The concepts of the "therapeutic alliance" (Zetzel, 1956) and "working alliance" (Greeson, 1965) are traced in their antecedents to Freud and other analysts and compared especially with Freud's "analytic pact." Differences both in theory and practice are elucidated with the aid of case material. While the therapeutic and working alliances are often used interchangeably, they are found to take up their positions at diametrically opposite points along a continuum defined by the analytic pact and show a marked tendency to depart from the guidance offered the traditional analysis by the fundamental rule. They should be regarded more as exercises in analytically oriented psychotherapy than parameters of the traditional technique. Nevertheless, as a basis for comparisons, it should be recognized that the latter technique: (1) does not formulate in theory many of the measures left for pragmatic fulfillment; (2) does not include genetic, structural and adaptive viewpoints that later developments require. Current tendencies to include the analyst's self-observations in relation to the total analytic process point up the growing influence of these more recent considerations.

Attitude of Health Personnel↗
PubMed2001

Perspective is everything: the predictive validity of six working alliance instruments.

The predictive validity of instruments commonly used to measure the therapeutic alliance was evaluated, using 46 sessions drawn from a clinical trial comparing manual-guided therapies for substance use. The California Psychotherapy Alliance Scale, Penn Helping Alliance Rating Scale, Vanderbilt Therapeutic Alliance Scale, and Working Alliance Inventory (Observer, Therapist, and Client versions) were rated for participants receiving either cognitive-behavioral therapy or twelve-step facilitation. All observer-rated instruments were significantly correlated with outcome; however, therapist-rated and client-rated instruments did not predict outcome. Findings suggest that the different observer-rated instruments are minimally different with respect to predictive validity, whereas patient- and therapist-rated measures may have a weaker relationship to outcome when highly objective outcome measures are used.

Adult↗
PubMed1975

Technical considerations of the therapeutic and working alliances.

A brief survey of the development of the idea of the analytic pact and its relationship to the concepts of the therapeutic and working alliances has been presented. I have suggested that the therapeutic alliance be defined as the full-scale therapeutic rapport which includes all the the elements favorable to the progress of therapy. This includes such factors as the patient's motivation for treatment based on ego-alien symptoms, positive transference, and the rational relationship between patient and therapist. I have considered the working alliance as more limited in scope and suggested that it be considered as referring to the healthier interpersonal interchange between the analyst and patient. In general, the relationship is in part dependent on the maturer portion of the patient's ego and is related to the reality relationship. I have ascribed the working alliance to the appropriate maturation of many of the ego's functions. It should be noted that the working alliance is actually one of the factors contributing to a good therapeutic alliance. Case reports have illustrated these considerations and amplified the discussion of the alliances, with emphasis on their technical management. These points are pertinent to the general conduct of therapy and the timing of interpretations. Care directed to the building of good alliances can be of great importance in creating a milieu conducive to therapeutic progress. Identification and its role in the development of the working alliance, and the special place of affection for the analyst were discussed and the differences between transference affection and the affection based on the realities between patient and therapist were related to the effects of interpretation.

Ego↗
PubMed2000

Role of the working alliance in the treatment of delinquent boys in community-based programs.

Examined the role of the working alliance in the treatment of delinquent boys in community-based residential programs, clarifying the relation between therapeutic process and behavioral change. Horvath and Greenberg's (1989) Working Alliance Inventory was used to assess the therapeutic alliance between youth and staff after 3 weeks in treatment and again after 3 months. Achenbach's (1991) Child Behavior Checklist (CBCL; Youth Self-Report [YSR] and Teacher Report Form [TRF]) and recidivism scores were used to assess treatment progress and outcome. Results indicated that a positive working alliance assessed after 3 months in treatment related to positive psychological changes and predicted lower rates of recidivism. Unexpectedly, a positive working alliance assessed early in treatment was associated with negative outcomes (increased internalizing and externalizing symptoms and higher rates of recidivism). This finding suggests that for some delinquent youth initially optimistic assessments may be prognostic of slow progress or treatment failure.

Adolescent↗
PubMed2002

Working alliance in online therapy as compared to face-to-face therapy: preliminary results.

Online therapy, defined as the provision of mental health services through the Internet, is a growing field that has sparked an abundance of interest and controversy. A primary concern in the practice of online therapy is whether a working alliance, considered a central component of successful therapy, can develop when participants are geographically separated. Working alliance scores were compared between a small, primarily female sample of online therapy consumers and a representative sample of traditional face-to-face therapy clients. Results revealed significantly higher means on the goal subscale and composite score of the Working Alliance Inventory in the online sample, suggesting that a working alliance can be adequately established in therapy delivered online. No significant differences in the level of working alliance were found within the online therapy sample with respect to modality of communication, client presenting problem, or therapist. Themes from comments suggest the importance for participants of the disinhibiting effects of the medium.

Adult↗
PubMedDate not supplied

Group cohesion and working alliance: prediction of treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy.

BACKGROUND: Various definitions of both group cohesion and working alliance are used in theories on group psychotherapy, making the study of their relative contribution to the treatment outcome difficult. In this study, two different, nonoverlapping questionnaires were used to explore the relationship between group cohesion, working alliance and treatment outcome in a time-limited, structured cognitive behavioral group psychotherapy aiming at the reduction of coronary risk factors. METHODS: After having undergone percutaneous transluminal coronary angioplasty, 42 patients were treated with the aim to reduce exhaustion, anxiety, hostility and depression. The newly developed Group Cohesion Questionnaire (GCQ) and the Helping Alliance Questionnaire (HAQ-II, measuring the bond between individual patients and the group psychotherapist) were administered after the fifth and tenth treatment session. Exhaustion, quality of life, anxiety, blood pressure and heart rate were measured before and after treatment. To test the relationship between the GCQ, the HAQ-II and outcome variables, Pearson Product-Moment correlations and hierarchical regression was applied. RESULTS: Principal Component Analysis of the GCQ yielded two dimensions, the bond with the group as a whole and the bond with other group members. Hierarchical regression showed that both the bond with other group members and working alliance contributed significantly and independently to the prediction of posttreatment systolic and diastolic blood pressure as well as posttreatment quality of life (confidence). CONCLUSIONS: Conceptually and empirically, group cohesion and the working alliance may be considered to represent different relationships in a psychotherapy group, contributing in different ways to the treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy.

Adult↗
PubMed1996

Counselors' adjective correlates of working alliance.

The authors present a study of 85 counselors' adjective descriptors of clients in relation to a working alliance. The imperative for such a study emerges from Cough's 1965 Conceptual Analysis of Test Scores approach to clinical measurement. For this investigation, all 300 items of the Adjective Check List were used. Working alliance was measured by the counselor's form of the Working Alliance Inventory-Short. Point biserial correlation of each adjective with inventory scores produced 54 significant adjectives. These 54 adjectives were 18 times the number expected by chance.

Adult↗
PubMed1995

The working alliance and consumer case management.

The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment.

Assertiveness↗
PubMed2001

Quality of working alliance in psychotherapy: therapist variables and patient/therapist similarity as predictors.

Therapist characteristics were explored as possible predictors of working alliance, rated early and later in therapy both by therapists (n=59) and patients (n=270) in an ongoing multisite project on process and outcome of psychotherapy. Patients and therapists had divergent perspectives on the working alliance. Therapists' experience, training, skill, and progress as therapists did not have any significant impact on alliance as rated by patients. Training and skill were positively related to alliance as rated by therapists. Interpersonal relationships on the cold-warm dimension had a moderate impact for both patients' and therapists' alliance ratings. Some implications for therapist training are discussed.

Adult↗
PubMed2000

Managed care organizations and academic medicine: establishing a more effective working alliance.

Instead of focusing solely on the demonization of "managed care" as an abstract concept, we suggest that institutions of medical education recognize that managed care in some form is here to stay. We believe it is critical that both academic institutions and managed care organizations work together to optimize health care delivery. In order to achieve this, we suggest that responsible physicians work toward the development of a more effective "working alliance" between managed care organizations and academic medical centers. This working alliance would involve the exchange of ideas and focused efforts by both parties to educate the other. Specific interventions are described.

Academic Medical Centers↗
PubMed2001

The factor structure of the working alliance inventory in cognitive-behavioral therapy.

Studies of the therapeutic alliance in cognitive-behavioral therapy (CBT) have varied in their results, necessitating a deeper understanding of this construct. Through an exploratory factor analysis of the alliance in CBT, as measured by the Working Alliance Inventory (shortened, observer-rated version), the authors found a two-factor structure of alliance that challenges the commonly accepted one general factor of alliance. The results suggest that the relationship between therapist and client (Relationship) may be largely independent of the client's agreement with and confidence in the therapist and CBT (Agreement/ Confidence), necessitating independent measures of these two factors, not one measure of a general alliance factor.

Adult↗