The Therapeutic Bond Scales: Psychometric characteristics and relationship to treatment effectiveness.

Abstract

The Therapeutic Bond Scales assess the quality of the therapeutic relationship from the patient's perspective. The therapeutic bond is composed of 3 aspects: working alliance, empathic resonance, and mutual affirmation. Scales were developed to measure these aspects and the therapeutic bond as a whole. The correlations between these scales and 2 measures of outcome (session quality assessed by the patient and termination outcome evaluated by nonparticipan t raters) were examined. All scales were significantly correlated with session quality. Therapeutic bond was significantly correlated with termination outcome in both a linear and a curvilinear fashion, suggesting that, at least in the initial phase of therapy, the therapeutic bond can be too high as well as too low. A substantial accumulation of empirical findings exists relating psychotherapy process variables to treatment outcome (cf. Orlinsky & Howard, 1986a). One of the most consistent findings in the psychotherapy research literature is that the quality of the relationship between the patient and the therapist is a major determinant of psychotherapeutic effectiveness (e.g., the therapeutic alliance literature: Alexander & Luborsky, 1986; Marmar, Horowitz, Weiss, & Marziali, 1986). Reviews (Gurman, 1977; Lambert, Shapiro, & Bergin, 1986; Orlinsky & Howard, 1986a; Patterson, 1984) consistently demonstrate that (a) a good therapeutic relationship is at least a major contributing factor, if not a necessary and sufficient condition (Rogers, 1957), for successful treatment, and (b) that the patient's perception of the quality of the relationship is most consistently positively related to outcome. Yet most systems for measuring this aspect of the therapeutic relationship are based on the nonparticipant observer perspective. The primary goal of the present study was to develop a reliable measure of the quality of the therapeutic relationship, from the patient's perspective, based on a theoretical model of the therapeutic bond. We also investigated the relationship between the quality of the bond, measured in this way in the early stage of therapy, and two measures of therapeutic effectiveness: an