Investigating the impact of counselling expectations as a moderator in buffering the negative association between relationship insecurity and the quality of working alliance

The working alliance between homeless young adults and workers: A dyadic approach

Until now, the relations between the working alliance and trauma-related symptoms have received little or no study in residential-care settings. However, considering the high prevalence of past experiences of interpersonal trauma among young people in residential centers, it is essential to examine this issue more closely. This study aimed to determine to what extent the strength of the working alliance, as reported by adolescent girls in residential centers and their counselors, is associated with the trauma-related symptoms that these girls reported subsequently, in emerging adulthood. The sample consisted of 130 adolescent girls placed in residential center. Trauma-related symptoms were measured at intake and approximately 4 years later, when all the girls were out of the center. Working alliance was measured 3 months after the start of the placement. Hierarchical multiple regressions were performed to determine the strength of the relationships between the working alliance during treatment and trauma-related symptoms in emerging adulthood. Findings showed that even after controlling for intake symptoms, the strength of the working alliance reported by the girls has modest, yet significant, negative associations with several trauma-related symptoms in emerging adulthood. The stronger the alliance the girls reported, the less they reported symptoms of depression, post-traumatic stress and externalization. Results suggest that a strong working alliance with adolescent girls may contribute to their recovery as it was associated with less trauma-related symptoms. Further research is needed to investigate the mechanisms and underlying factors explaining this relationship at short, medium and long term.

A strong therapeutic alliance between cancer patients and medical staff is associated with treatment adherence, better health outcomes, and an emotional acceptance of a terminal illness. Given its significant role, the current study investigated the association between the working alliance and sharing concerns by advanced cancer patients. Advanced cancer patients completed the Working Alliance Inventory-Short Revised and a checklist of topics in which they rated their degree of concern about the topics and the degree of sharing them with their physician/nurse. Fifty-two patients completed the study. The working alliance was found to be strong with respect to treating physicians and nurses. The four topics that concerned patients the most were family coping with their illness (81%), fear of future suffering (71%), symptom control (67%), and the oncological treatment (65%). Patients with a strong working alliance with their physician shared to a higher extent the personal and main concern regarding their family's coping, and a significant correlation was found between them (r = 0.53, p < .01). In addition, sharing fears of future suffering was also correlated with a strong working alliance with the physician (r = 0.28, p < .05). A strong working alliance with the nurse was correlated with discussing symptoms control (r = 0.30, p < .05). These findings provide preliminary support for an association between the strength of the working alliance and the type of concerns that advanced cancer patients choose to discuss with their medical staff and highlight the importance of follow-up studies to further explore this association.

Working alliance between patients with a first-episode psychosis and their case manager is regarded as a key element in specialized early intervention services. The impact of this patient-case manager dyad on functional and clinical outcome is unknown. We aimed to investigate if a strong working alliance was associated with fewer clinical symptoms and better social functioning. In a cross-sectional design, patients with first-episode schizophrenia spectrum disorders (ICD-10, F20-29) were included after 18 months of treatment (N = 400). Baseline data were collected between June 2009 and December 2011. Symptoms were assessed using Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment of Functioning (GAF), Brief Assessment of Cognition in Schizophrenia (BACS), Working Alliance Inventory (WAI), and General Self-Efficacy (GSE). Linear regression analyses were adjusted for age, sex, cognition, and self-efficacy. Results revealed significant associations between working alliance and fewer negative (β = -0.12; 95% CI, -0.19 to -0.04) and disorganized symptoms (β = -0.06; 95% CI, -0.11 to -0.01), and between working alliance and better social functioning (β = 1.45; 95% CI, 0.55 to 2.36). General self-efficacy mediated the effect of working alliance, explaining 14%-18% of the variance in associated outcomes. Global level of cognitive functioning, compliance, and self-efficacy influenced clinical and functional outcome more strongly than working alliance. Better working alliance was weakly associated with fewer negative and disorganized symptoms and better social functioning. A strong working alliance may be a prerequisite for adherence to the specialized early intervention services treatment, providing the basis for positive treatment outcome. ClinicalTrials.gov identifier: NCT00914238.

Journal Article An Exploration of the Working Alliance in Mental Health Case Management Get access David C. Kondrat, PhD, MSW, David C. Kondrat, PhD, MSW assistant professor Utah State University, Department of Sociology, Social Work, and Anthropology, 0730 Old Main, Logan, UT 84322-0730; e-mail: david.kondrat@usu.edu Search for other works by this author on: Oxford Academic Google Scholar Theresa J. Early, PhD, MSW Theresa J. Early, PhD, MSW associate professor College of Social Work, Ohio State University, Columbus Search for other works by this author on: Oxford Academic Google Scholar Social Work Research, Volume 34, Issue 4, December 2010, Pages 201–211, https://doi.org/10.1093/swr/34.4.201 Published: 01 December 2010 Article history Received: 21 October 2008 Revision received: 09 July 2009 Accepted: 10 July 2009 Published: 01 December 2010

This study compared counseling expectations of Icelandic and U.S. college students, investigated counseling expectations as a function of sex, and explored the relationship between counseling expectations and Holland’s typology. It was discovered that the Icelandic students expected greater expertise from the counselor than did the U.S. students and the U.S. students expected the counseling conditions to be more facilitative than did the Icelandic students. Also, women, as compared with men, expected counseling to be more facilitative of change and expected to be more personally committed to the counseling process, whereas men expected more counselor expertise. A canonical correlation analysis revealed a significant relationship between counseling expectations and Holland’s Social and Realistic personality types for the U.S. students and Holland’s Social type for the Icelandic students.

It has been suggested that a strong working alliance encourages clients to take risks during therapy (Raue, Castonguay, & Goldfried, 1993). This encouragement may be important for clients who fear negative evaluations as they engage in risk‐taking elements of therapy. This study examined the relationship between working alliance, session helpfulness and measures of emotional processing in 18 clients undergoing cognitive behavior therapy (CBT) for social anxiety disorder. Results indicate a positive correlation between client‐rated, but not observer‐rated, working alliance and session helpfulness. Moderate levels of working alliance were associated with higher initial anxiety and deeper within‐session habituation. Overall, a strong alliance was associated with clients engaging with the session and finding the session helpful. Implications for the use of CBT for social anxiety are discussed.

The influence of the working alliance on the treatment and outcomes of patients with bipolar disorder: A systematic review

Purpose Working alliance is one of the most important common factors for successful counseling/psychotherapy outcomes. Based on the empirical literature about working alliance, it seems that self-determination and self-efficacy theory (SDT/SET) can potentially be used as a motivational model to explain the relationship between working alliance and vocational rehabilitation (VR) outcomes. The purpose of this study is to evaluate three primary SDT/SET constructs, autonomous motivation, expectancy and engagement, as mediators for the relationship between working alliance and stages of change (SOC) for employment. Methods A serial multiple mediation analysis (SMMA) was computed to evaluate autonomy, outcome expectancy, and VR engagement as mediators of the relationship between working alliance and SOC for employment in a sample of 277 people with chronic illness and disability (CID) receiving services from state VR agencies in the United States. Results The SMMA results indicated that working alliance was positively associated with SOC for employment (total effect), while the direct effect between working alliance and SOC for employment was not significant after controlling for the effects of the mediators, indicating significant mediation effects. The mediation effects were estimates of the indirect effects for working alliance on SOC for employment through (a) autonomous motivation, (b) outcome expectancy, (c) VR engagement, and (d) autonomous motivation, outcome expectancy and VR engagement together. Conclusions The results indicated that a strong working alliance has the benefit of helping consumers develop autonomous motivation to work and increasing their vocational outcome expectancy and engagement in VR services, leading to employment.

Intensive treatment programs (ITPs) are successful at reducing posttraumatic stress disorder (PTSD) and depression symptoms in veterans. However, the role of the working alliance in the context of ITPs is largely unexplored. The purpose of this study was to examine veteran-rated working alliance with their individual cognitive processing therapy (CPT) provider as a predictor of changes in PTSD and depression symptoms as well as negative posttrauma cognitions in two unique ITP formats. Data were collected from 128 veterans who completed a 2-week ITP, involving 2 × individual CPT/day, as well as 73 veterans who completed a 3-week ITP, involving 1 × group CPT/day and 1 × individual CPT/day. Both ITPs included adjunctive wellness, skills, and psychoeducation services in addition to CPT. Linear mixed-effects models were used to determine whether changes in working alliance predicted changes in PTSD and depression symptoms. Stronger veteran-reported working alliance with their individual CPT therapist, most notably agreement on tasks, predicted significant reductions in both the 2-week and 3-week programs in PTSD (ps = .012 and .002, respectively) and depression symptoms (ps = .009 and .007, respectively) and negative posttrauma cognitions (ps = .009 and .016, respectively). These results highlight the importance of veterans' perceived working alliance with their individual treatment therapists in ITPs. Results suggest that a strong working alliance that is meaningful for treatment outcomes can be developed quickly despite the brevity of this intensive treatment format. Future research should examine ways to facilitate the development of a strong working alliance prior to or as early as possible in ITPs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive Behaviour Therapy (CBT) has the strongest preliminary support for treatment of depression and anxiety following traumatic brain injury (TBI). TBI associated cognitive impairments may pose an obstacle to development of a strong working alliance, on which therapeutic gains depend. The current study examined the association of demographic (i.e., gender, age at study entry, years of education and premorbid IQ) and injury-related (i.e., years since injury, post-trauma amnesia duration, memory and executive functioning test performance) variables with alliance in CBT adapted for TBI (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions from 31 participants were assessed with an observer version of the Working Alliance Inventory at nine time-points. Multi-level mixed model regressions showed that participants and therapists maintained a relatively strong alliance across all sessions. Pre-intervention symptom severity was considered as a confounder variable and was found to have no statistically significant influence on the models. None of the demographic variables were significantly associated with alliance scores. More years since injury was associated with a stronger alliance. These findings demonstrate that TBI associated cognitive impairments do not necessarily pose an obstacle to development and maintenance of a strong working alliance, which is more likely to develop with more time post-brain injury.

Purpose: The aim was to review the empirical literature to determine the nature and breadth of research into the working alliance in acquired brain injury (ABI) rehabilitation.Methods: A scoping review was conducted, beginning with a systematic search of relevant databases using key search terms. Studies with a focus on the role of the working alliance in shaping rehabilitation outcomes, and factors influencing perceptions of the working alliance were included and key information extracted.Results: A total of 10 quantitative studies met inclusion criteria. In most studies, ratings of the working alliance were compared with other process variables or outcome measures. The working alliance was linked to positive activity and participation outcomes, including return to work, school, and driving. Client related factors such as age, level of education and approach to rehabilitation tasks were associated with client and therapist perceptions of the working alliance.Conclusions: The working alliance emerged as a complex process that interacts with many factors and processes at play in the rehabilitation environment. Notwithstanding the limitations of the research base, findings indicate that enhancement of the working alliance may indeed influence rehabilitation outcomes. Allowing time for the development of the working alliance, and consideration of factors such as therapist skill, may support therapists to strengthen their alliances in ABI rehabilitation.Implications for RehabilitationAllowing time for the development of the working alliance has the potential to enhance the alliance and thereby influence rehabilitation outcomes.Factors such as the client’s age and level of education may influence the strength of the working alliance, and hence, awareness of these factors may assist clinicians in maintaining strong alliances with all clients.A strong working alliance is possible in the presence of client cognitive impairment, however, the skill of the therapist may be important in managing the potential impact of cognitive impairment on the working alliance.

BackgroundThe cooperative and dynamic relationship between patients and therapist known as Working Alliance, has in two meta-analysis shown to be an important factor for positive outcome in psychotherapy regardless the modality of therapy. Studies investigating the association between working alliance and outcome conducted in cohorts of patients with mental illness treated in a case manager setting has reported an association between a strong working alliance and reduced symptom severity, better social function, adherence to psycho-social treatment.For this study, we used data from a trial testing the effect of five years of specialized early intervention (SEI) compared to two years of SEI for patients diagnosed with first episode of schizophrenia spectrum disorder. We aimed to study the effect of the intervention on the working alliance and the change in working alliance as a dynamic factor in the two treatment conditions from baseline to follow-up.When extending specialized early intervention from two to five years’ vs transferring to treatment as usual, we hypothesized a change in working alliance and psychopathology favoring the patient in the extended SEI group.MethodsParticipants were recruited from SEI teams (OPUS) in Denmark. All newly diagnosed within the schizophrenia spectrum (ICD-10, F2), age between 18 and 35. Participants were included 1 ½ year after initiation of SEI treatment (baseline) and followed up 5 years after initiation of treatment. At both assessments participants were examined with a comprehensive assessment battery including working alliance, psychopathology, social function, cognitive function, adherence to medication and client satisfaction. Assessors were blind to treatment allocation. The primary outcome, working alliance inventory (WAI), was assessed by self-assessment.A change score was calculated by subtracting the baseline score from the follow-up score. Multivariable linear regression analyses were conducted, corrected for the baseline value of the independent and dependent variable.ResultsOf the 289 participants who attended the follow-up interview 258 (89%) had completed the WAI at baseline and follow-up. Participants who were randomized to prolonged SEI had a stable WA from baseline to follow-up, while participants who were randomized to TAU had a mean drop in WA over the same period.Change in WA was associated with change in negative-, psychotic-, and disorganized symptoms dimension, and social function in the extended OPUS group. In the TAU group, we found that change in WA were negatively associated with change in cognitive function measured with BACS. In both groups, there were an association between the change in WA and change in client satisfaction.DiscussionThis indicates that those participants’ who continued the extended SEI treatment maintained their experiences of a strong WA with their case manager, while those participants who were transferred to TAU experiences a lower degree of WA with their case manager compared to their time in SEI treatment. Furthermore, the participants who increased on their cognitive functioning were less likely to assess WA positively if they were transferred to TAU.

This preliminary study examined the similarities and differences between online and face-to-face counseling with regard to general mental health, working alliance, and social presence. Participants included 50 current counseling clients (37 face-to-face, 13 online) who all were recruited through online mediums. Results indicated that online counseling clients perceived a significantly stronger working alliance on the total Working Alliance Inventory-Short Form as well as the Goal subscale than did those who received face-to-face only counseling. No significant differences existed between the groups on general mental health or social presence. These results suggest that a more controlled study with a larger sample might find that a strong working alliance can be developed through online counseling.

Strong working alliance is a critical part of rehabilitation counseling, yet few studies have explored client predictors of alliance. Based on interpersonal theory, this study investigated the relationship between client interpersonal problems and working alliance during vocational rehabilitation. A sample of 325 individuals with disabilities from two state vocational rehabilitation agencies participated in the study. Bivariate analyses showed that greater interpersonal problems were associated with weaker working alliance. In a hierarchical regression analysis, submissive/hostile interpersonal problems significantly predicted lower working alliance scores. These findings suggest that interpersonal problems, such as social withdrawal and emotional disengagement, impede the development of working alliance. The results support the integration of interpersonal assessments and alliance-focused strategies into rehabilitation counseling to enhance engagement and improve client outcomes.