Associations between therapeutic working alliance and social cognition in neuro-rehabilitation

Abstract

The aim of this study was to investigate the impact of brain injury survivors´ social cognition abilities on their working alliance with their therapist. Participants in this study were individuals who were enrolled in a vocational rehabilitation programme for acquired brain injury. Seventy-two individuals with complicated mild to severe acquired brain injury (49%TBI, 38% stroke, 14% other injury; mean age 44.9 years; 75% male) entered in the study between 1.5 and 31 years after their injury (Md=5 years). The therapeutic alliance was rated retrospectively at the time of study by the participants´ primary therapists on the Working Alliance Inventory (WAI). Social cognition measures (Reading the Mind in the Eyes Test, Recognition of Faux Pas Test, The Awareness of Social Inference Test, TASIT; Social Situations Task, Bangor Gambling Task) were administered as well as a standard neuropsychological test battery and the Hospital Anxiety and Depression Scale. Multilevel analyses revealed that both the TASIT and the Social Situations Task, but neither the standard neuropsychological tests nor the HADS were significantly related to WAI ratings. These findings indicate the impact that difficulties with emotions recognition and social rule violations can have on the formation of a therapeutic alliance.