Abstract
BackgroundThe Helping Alliance Questionnaire (HAQ) is a frequently used and highly relevant instrument to assess the therapeutic alliance. The questionnaire was translated into German by Bassler and colleagues (1995) and is available for patients (HAQ-P) and therapists (HAQ-T). Whereas the HAQ-P has been tested regarding psychometrics, the HAQ-T has not. This study aimed at further investigating the psychometric properties of both the HAQ-P and HAQ-T. We hypothesized that the instrument is reliable and shows factorial as well as convergent validity.MethodsWithin the framework of a multisite, randomized-controlled clinical trial, comparing the efficacy of Cognitive Behavioral Analyses System of Psychotherapy (CBASP) and supportive psychotherapy (SP) in the treatment of early onset persistently depressed outpatients, the HAQ was filled out by patients (n = 255) and therapists (n = 81). 66.0% of patients were female; average age at randomization was 44.9 years (SD = 11.8). Several confirmatory factor analyses were conducted to test different structures for the HAQ. In addition, correlations between the HAQ and the Inventory of Interpersonal Problems (IIP) were calculated to test for convergent validity.ResultsGoodness of fit indices for both a model with two different but strongly related factors named ‘relation to the patient/ therapist ’ and ‘satisfaction with therapeutic outcome’ and a second model with only one global helping alliance factor were comparable: Chi-Square-based indices rejected the models; RMSEA closely approached the threshold of good model fit, and CFI/ TLI and SRMR suggested that both models sufficiently fit the data. The internal consistency (Cronbach’s α) calculated for the different scales of the HAQ ranges between questionable to good. Finally, the HAQ scores were significantly related to some of the IIP scores.ConclusionsThe German versions of the HAQ offer sufficient reliable instruments for the quick assessment of different facets of the therapeutic alliance. The HAQ global scores can be used as indicators for the global impression of the patients and therapists perception of the quality of the therapeutic alliance. However, the small correlations found between the IIP and the HAQ puts the question of external validity into perspective.Trial registrationThis study analysed data from a RCT which was registered on ClinicalTrials.com (NCT00970437). First submitted on September 1, 2009.
Highlights
The Helping Alliance Questionnaire (HAQ) is a frequently used and highly relevant instrument to assess the therapeutic alliance
The relationship between patient and therapist is one important factor in psychotherapy which predicts therapy outcome [1, 2]. One perspective on this relationship is the concept of alliance which was originally defined by Bordin [3] and “describes the degree to which the therapy dyad is engaged in collaborative, purposive work” [4]
The hypotheses were tested with data from a randomized controlled trial (RCT) comparing the efficacy of the Cognitive Behavioural Analysis System of Psychotherapy (CBASP) to an active control group, i.e. supportive psychotherapy (SP)
Summary
The Helping Alliance Questionnaire (HAQ) is a frequently used and highly relevant instrument to assess the therapeutic alliance. The relationship between patient and therapist is one important factor in psychotherapy which predicts therapy outcome [1, 2] One perspective on this relationship is the concept of alliance which was originally defined by Bordin [3] and “describes the degree to which the therapy dyad is engaged in collaborative, purposive work” [4]. The Working Alliance Inventory [7] is directly derived from Bordin’s theory of alliance [4] It measures the agreement of patient and therapist on goals for and tasks in therapy as well as the affective bond between patient and therapist [7]. While there is the HAq-II (for patients, therapists and observers), the HAQ is still widely used and recommended for research [15, 16]
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