Alliance Questionnaire Research Articles

Feasibility and acceptability of a telehealth, individually-tailored healthy lifestyle intervention for adolescent and young adult pediatric cancer survivors.

Poor nutrition and physical activity pose negative health risks for adolescent and young adult pediatric cancer survivors (AYACS). Our pilot randomized controlled trial (RCT) evaluated feasibility and acceptability of a telehealth intervention (ENHANCE) supporting AYACS' nutrition and physical activity. We randomized 58 AYACS and their adult care partner, when applicable, to the ENHANCE or control condition. Inclusion required an age of 15-25 years, previous chemotherapy or radiation therapy, and no eating disorder history. We utilized a 2:1 (ENHANCE [n = 35]: control [n = 23]) double-blind block randomization protocol in blocks of 6. ENHANCE comprised 12 (60-min) sessions that included education, skill-building, and values-based healthy lifestyle decision-making. The first five sessions included motivational interviewing and the final seven sessions included problem-solving training/goal setting. We evaluated feasibility based on eligibility, enrollment, attrition, and study completion percentages. We assessed fidelity using the Session Content-Fidelity Rating Tool and the Motivational Interviewing Treatment Integrity Coding form. We assessed acceptability using the Abbreviated Acceptability Rating Profile, the Revised Helping Alliance Questionnaire, and participants' exit interviews. ENHANCE was feasible and highly acceptable; all but one participant who started the intervention completed all 12 sessions and all participants reported enjoying the intervention via objective assessment and during exit interviews. Interventionists delivered ENHANCE with high fidelity. ENHANCE was highly acceptable among AYACS and care partners. The telehealth study design was feasible, suggesting benefits and feasibility of a future, larger, multisite RCT. Promising findings support our methodological decisions as important considerations to inform a larger RCT.

The development of the therapeutic alliance during the first five hypnotherapy sessions

The therapeutic alliance is a principal element that allows the dynamics and effects of psychotherapy to be analyzed. In the past half-century, many studies have explored various psychotherapeutic approaches, including psychoanalytic, cognitive-behavioral and systemic psychotherapy, but hypnotherapy has not been addressed. This article presents the first analysis using current methods of verifying and understanding the dynamics of change in hypnotherapy, regarding to the therapeutic alliance. Luborsky et al.‘s (1996) revised Helping Alliance Questionnaire (HAq-II) was administered to 59 patients in treatment with psychologists and psychiatrists using Ericksonian hypnosis. Our results suggest that the dynamics of the alliance in the first sessions of hypnotherapy involve factors related more to the therapist's adjustment to the patient than to the progress the patient makes in these initial sessions.

Assessment of Movement Synchrony and Alliance in Problem-Focused and Solution-Focused Counseling

The present study investigated the differences in movement synchrony and therapeutic alliance between solution-focused and problem-focused counseling. Thirty-four participants each attended two counseling sessions with different counselors, one with a solution-focus and one with a problem-focus, in randomized order. The sessions consisted of three consecutive parts: problem description, standardized intervention and free intervention. Movement synchrony, including leading and pacing synchrony, was measured using Motion Energy Analysis (MEA) and windowed cross-lagged correlation (WCLC) based on video recordings of the sessions. The Helping Alliance Questionnaire (HAQ) was used to assess therapeutic alliance. Results showed that movement synchrony was significantly higher in solution-focused than in problem-focused counseling, driven by differences in the problem description part. This difference may be explained by the allegiance of the counselors to the solution-focused approach, as we observed more leading synchrony during the problem description part in solution-focused sessions. There was no significant difference in therapeutic alliance between the two conditions. This study expands the understanding of counseling approaches in the field of movement synchrony and contributes valuable insights for practitioners and researchers alike.

The psychometric properties and treatment outcomes associated with two measures of the adult therapeutic alliance using naturalistic data

AbstractPurposeThis is the first of two articles that examine the psychometric properties and treatment outcomes associated with measures of the therapeutic alliance collected in naturalistic settings rather than clinical trials. These articles break new ground in understanding the relationship between measures of alliance and treatment outcome by performing detailed item analyses in order to assess the psychometric properties of each individual item, its propensity to change from session to session and its utility in predicting change in the outcome measure.MethodsData were taken from the ACORN database for adults attending for psychotherapy treatment in naturalistic settings (N = 147,399). The sample, the largest to date, included only those completing both an alliance measure and an outcome measure at every session. Two sets of three different alliance items are used across three different treatment populations: general outpatient, substance use, and severe and persistent mental health difficulties. To investigate this possibility, the psychometric properties of each item were evaluated, including factor analysis, likelihood of change over time in treatment and correlations between changes in alliance and magnitude of client‐reported improvement in therapy. The predictive validity of each individual item is compared with the predictive validity of their respective three‐item measures. The problem of alliance scores being heavily skewed in a positive direction and the resulting lack of variability from session to session is addressed by categorising change in alliance as same, better or worse, regardless of the magnitude of change.ResultsFindings tended to differ from those in clinical trials, with the last alliance score being most predictive of outcome. In this data set, the alliance accounted for, at most, 2% of the variance in outcomes. Measures of the therapeutic alliance demonstrate ceiling effects, and the alliance–outcome correlation is far from linear. Change in alliance score, rather than a single assessment, is more predictive of outcome, regardless of the magnitude of change in the alliance measure, with effect sizes of up to 50% more for those who rated the alliance as worse than for those rating it as no change or better.ConclusionTherapists using therapeutic alliance questionnaires will benefit from being aware of how the psychometric properties of alliance measures impact outcomes. Even the smallest drop in alliance is predictive of significant clinically meaningful differences. Implications for practice, training and research are considered.

Dynamic and static predictive modelling of psychotherapy outcome-Comparison of two statistical approaches.

Improving prediction abilities in the therapy process can increase therapeutic success for a variety of reasons, such as more personalised treatment or resource optimisation. The increasingly applied methods of dynamic prediction seem to be very promising for this purpose. Prediction models are usually based on static approaches of frequentist statistics. However, the application of this statistical approach has been widely criticised in this research area. Bayesian statistics has been proposed in the literature as an alternative, especially for the task of dynamic modelling. In this study, we compare the performance of predicting therapy outcome over the course of therapy between both statistical approaches. Based on a sample of 341 patients, a logistic regression analysis was performed using both statistical approaches. Therapy success was conceptualised as reliable pre-post improvement in brief symptom inventory (BSI) scores. As predictors, we used the subscales of the Outcome Questionnaire (OQ-30) and the Helping Alliance Questionnaire (HAQ) measured every fifth session, as well as baseline BSI scores. The influence of the predictors during therapy differs between the frequentist and the Bayesian approach. In contrast, predictive validity is comparable with a mean area under the curve (AUC) of 0.76 in both model types. Bayesian statistic provides an innovative and useful alternative to the frequentist approach in predicting therapy outcome. The theoretical foundation is particularly well suited for dynamic prediction. Nevertheless, no differences in predictive validity were found in this study. More complex methodology as well as further research seems necessary to exploit the potential of Bayesian statistics in this area.

Competence Ratings in Psychotherapy Training – A Complex Matter

BackgroundThe reliable assessment of competence is crucial for promoting the professional development of therapists. However, competence assessments are rarely included in training and research as these procedures are resource-intensive and costly, commonly relying on independent raters with high levels of expertise and extensive training. This study aimed to compare the interrater reliability (IRR) of raters with different levels of expertise. We also examined the impact of different camera perspectives on IRR.MethodsWe examined the IRR of six independent raters based on competence assessments in a standardized setting. Two raters were experienced psychotherapists (experts), and four were psychology students (novices; with/without supervision). All raters evaluated N = 359 videos of students performing role plays with standardized patients who were simulating depressive symptoms and behavior. For each video, the raters independently assessed basic communication skills (Clinical Communication Skills Scale–Short Form; CCSS-S), psychotherapeutic competence (Cognitive Therapy Scale; CTS), empathy (Empathy Scale; ES) and therapeutic alliance (Helping Alliance Questionnaire; HAQ).ResultsIRR varied depending on rater expertise and assessment measures, with the lowest intraclass correlation coefficients (ICCs) for empathy (ES; ICCs = 0.39-0.67) and the highest ICCs for psychotherapeutic competence (CTS; ICCs = 0.66-0.78). The concordance between expert raters and supervised novice raters was good (ICCs = 0.71-0.86). The camera perspective did not influence the reliability of the ratings.ConclusionsWith appropriate training and regular supervision, the novices assessed therapeutic behavior in standardized role plays with reliability comparable to that of the experts. Further research is needed regarding the reliable assessment of more complex therapy situations.

Does treatment specific-, disorder specific- or general therapeutic competence predict symptom reduction in posttraumatic stress disorder?

ABSTRACT Background: Literature on the association between therapist competence and treatment success in posttraumatic stress disorder (PTSD) treatments is scarce and results are mixed. Aims/Objective: The relationship between different types of therapeutic competence, therapeutic alliance, and PTSD symptom reduction in patients treated with Dialectical Behaviour Therapy for PTSD (DBT-PTSD) or Cognitive Processing Therapy (CPT) was assessed. Competence types were PTSD-specific competence, treatment specific competence, and general competence in cognitive behaviour therapy (CBT). Method: Videotaped therapy sessions from N = 160 women with PTSD and emotion regulation difficulties after child abuse participating in a large randomised controlled trial (Bohus et al., 2020) were rated. Three therapeutic competence-types were assessed using specifically developed rating scales. Alliance was assessed via patient ratings with the Helping Alliance Questionnaire (HAQ). PTSD symptoms were assessed at pre- and post-treatment via clinician rating with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and via self-rating with the PTSD-Checklist for DSM-5 (PCL-5). Results: No significant association between competence and clinician or self-rated PTSD symptoms was found. PTSD specific competence predicted clinician rated PTSD symptom severity on a trend level. Alliance predicted both clinician and self-rated PTSD symptom reduction. Conclusion: Our results provide a starting point for future research on different competence types and their association with PTSD treatment gains. Therapists were highly trained and received weekly supervision, hence a restricted competence range is a possible explanation for non-existing associations between competence and PTSD symptom reduction in our sample. More research in naturalistic settings, such as dissemination studies, is needed.

Psychometric properties of the GP-Patient Relationship Questionnaire as an instrument for quality improvement in Germany

IntroductionSince the patient-doctor relationship (PDR) plays a crucial role in patient primary health care and management, the evaluation of the PDR from both, the patients’ and primary care physicians’, perspectives is an important approach to improve the quality of primary care. However, although there are a variety of questionnaires surveying the patients’ view of the PDR, only few consider the physicians’ perspective. The purpose of this study was to develop a questionnaire that adds the physicians’ perspective to an existing PDR instrument and thus enables a mutual assessment of the relationship. MethodsThis study was embedded in a German project aiming at enhancing the adherence in patients with hypertension. Patients and primary care physicians were asked to complete a questionnaire concerning their PDR. The Patient-Doctor Relationship Questionnaire (PDRQ-9) was used to assess the patients’ perspective. For the physicians, the PDRQ-9 items were adapted to the physicians’ perspective resulting in the GP-Patient Relationship Questionnaire (GPPR). The Helping Alliance Questionnaire (HAQ) was used for external validation. ResultsA total of 60 physician questionnaires and 50 matched pairs of questionnaires from physicians and patients were included in the analyses. Within the analysis, notable deviations were found for one item, nevertheless the calculated Cronbach’s α of 0.89 showed a high internal consistency of the 9-item questionnaire. External validation showed a high correlation of the GPPR with the HAQ, confirming the good psychometric properties demonstrated for the overall instrument. DiscussionOverall, this initial validation study revealed good psychometric properties of the GPPR. A retest will be performed in the course of the overall project to confirm the reliability of the newly developed questionnaire. ConclusionA new questionnaire to assess the physicians’ perspectives on the PDR was successfully developed to improve adherence-dependent processes of quality improving in primary care.

Therapeutic alliance in psychotherapy across online and face-to-face settings: A quantitative analysis

Lockdown enacted by government in response to the Covid-19 pandemic in Austria forced psychotherapy practice into an online-only setting for several months in 2020. Although there is evidence supporting the effectiveness of psychotherapy in remote settings, research investigating therapeutic alliance in online psychotherapy is still limited, with a specific need for research in assessing possible effects of changes in therapeutic setting from face-to-face to online and vice versa. We measured therapeutic alliance in client-therapist dyads using the Helping Alliance Questionnaire (HAQ) at the Adult Outpatient Clinic of Sigmund Freud University, Vienna. Eighty-seven dyads completed HAQ twice, assessing three time-points: after switching from face-to-face to online therapy, providing a retrospective assessment of their alliance before the setting change as well as a concurrent account of their experience during online therapy, then another assessment after switching back to face-to-face setting after lockdown restrictions were lifted. Data were analysed by fitting a multilevel linear model, where the variables person (client/therapist) and time (before online therapy; online therapy; back to face-to-face) were nested within the client-therapist dyad. We found a statistically significant small improvement in the quality of therapeutic alliance over time, but no differences due to change in therapeutic setting. Separate analysis of HAQ sub-scales revealed that clients rated their relationship statistically significantly higher than their therapists with medium effect size, while there were no differences in success ratings over time and settings, nor between clients and therapists. The findings support the feasibility of online therapy in terms of therapeutic alliance in general, and alternating between face-to-face and online therapy settings in particular.

Therapeutic Alliance in Web-Based Treatment for Eating Disorders: Secondary Analysis of a Randomized Controlled Trial.

BackgroundIn face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy (web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists.ObjectiveThis study aimed to investigate TA ratings measured at interim and after treatment, separately for patients and therapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings; and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion.MethodsA secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eating disorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder not otherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping Alliance Questionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclass correlations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists. A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predicted eating disorder pathology and therapy completion.ResultsFor treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients and therapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreased significantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightly better after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatment were associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patient scores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion.ConclusionsOur study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Of particular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predicting posttreatment eating disorder pathology and treatment completion.

Predictors of therapeutic alliance, treatment feedback, and clinical outcomes among African American women in treatment for co-occurring PTSD and SUD

IntroductionBlack women are at heightened risk for trauma exposure, post-traumatic stress disorder (PTSD), and substance use disorders (SUDs), compared to White women and the general population. However, disparities in treatment engagement and retention persist, particularly for Black women with co-occurring PTSD+SUD. Although therapeutic alliance is an important predictor and mediator of treatment retention and outcomes, we know little about predictors of alliance and the mediating role of alliance for PTSD+SUD outcomes among Black women. MethodsThis study utilized data previously collected for the National Drug Abuse Treatment Clinical Trials Network (CTN) Women and Trauma Study. Participants were 88 Black/African American women (Mage = 41.90, SD = 7.72) participating in a clinical trial comparing Seeking Safety (a cognitive-behavioral intervention for PTSD+SUD) to Women's Health Education (control). This study includes participants from both arms. Measures included the Helping Alliance Questionnaire, Addiction Severity Index-Lite, and Clinician Administered PTSD Scale. Women in the intervention arm also completed the Seeking Safety Feedback Questionnaire. ResultsStepwise, hierarchical linear regressions indicated that years of education and previous alcohol/drug treatment attempts significantly predicted early alliance in the second week of therapy (β = 0.411, p = .021 and β = 0.383, p = .011, respectively), but not late alliance in the last week of therapy (ps > .794). Greater education and more treatment attempts were associated with higher early alliance. Alliance did not mediate relationships between these significant predictors and treatment outcomes (e.g., attendance, post-treatment PTSD and SUD symptoms) or treatment feedback in the Seeking Safety group. ConclusionsEducation and prior treatment attempts predicted early alliance among Black/African American women in PTSD+SUD group treatment, and higher education level was associated with poorer Seeking Safety feedback topic ratings. Educational level and treatment history should be considered during alliance building in therapeutic interventions with Black women. Clinicians may consider the integration of pre-treatment alliance-building strategies with Black female patients who have lower levels of education. This study provides insight into the relative impact of several important factors that influence early alliance among Black women with co-occurring PTSD+SUD.

The influence of vocal synchrony on outcome and attachment anxiety/avoidance in treatments of social anxiety disorder.

Research indicates an effect of nonverbal synchrony on the therapeutic relationship and patients' symptom severity within psychotherapy. However, vocal synchrony research is still rare and inconsistent. This study investigates the relationship between vocal synchrony and outcome/attachment dimensions, controlling for therapeutic alliance and movement synchrony. Our sample consisted of 64 patients with social anxiety disorder. Symptom severity was assessed with the Liebowitz Social Anxiety Scale and the Inventory of Interpersonal Problems, whereas attachment was assessed with the Experiences in Close Relationships Questionnaire at the beginning and end of therapy. Therapeutic alliance was measured with the Helping Alliance Questionnaire II. We determined vocal synchrony of the median and range of the fundamental frequency (f 0) by correlating f 0 values of manually segmented speaker turns. Movement synchrony was assessed via motion energy and time-series analyses. Patient- and therapist-led synchrony was differentiated. Statistical analyses were performed using mixed effects linear models. Vocal synchrony had a negative impact on outcome. Higher vocal synchrony led to higher symptom severity (if the patient led synchrony, at the end of therapy) as well as attachment anxiety, avoidance, and interpersonal problems at the end of therapy. Predicting attachment anxiety, the effect of therapist-led vocal synchrony went beyond the effect of therapeutic alliance and movement synchrony. High vocal synchrony may arise due to a lack of autonomy in social anxiety disorder patients or might reflect attempts to repair alliance ruptures. The results indicate that vocal synchrony and movement synchrony have different effects on treatment outcome. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of competence feedback on therapist competence and patient outcome: A randomized controlled trial.

Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome. Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions. (a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy. Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Negative effects of psychotherapy: estimating the prevalence in a random national sample

Background Negative or adverse effects of psychological treatments are increasingly a focus of psychotherapy research. Yet, we still know little about the prevalence of these effects. Aims Starting from a representative national sample, the prevalence of negative effects and malpractice was determined in a subsample of individuals reporting psychotherapy currently or during the past 6 years. Method Out of an initial representative sample of 5562 individuals, 244 were determined to have had psychotherapy within the past 6 years. Besides answering questions related to treatment, its effects and the therapists, patients filled out the Negative Effects Questionnaire, items of the Inventory of Negative Effects of Psychotherapy reflecting malpractice and the Helping Alliance Questionnaire, and rated psychotherapeutic changes in different areas. Results Rates of positive changes related to therapy varied between 26.6% (relationship to parents) and 67.7% (improvement in depressed mood). Deteriorations were most commonly related to physical well-being (13.1%), ability to work (13.1%) and vitality (11.1%). Although patients generally reported a positive helping alliance, many of them reported high rates of negative effects (though not always linked to treatment). This was especially true of the experience of unpleasant memories (57.8%), unpleasant feelings (30.3%) and a lack of understanding of the treatment/therapist (19.3/18.4%). Indicators of malpractice were less common, with the exception that 16.8% felt violated by statements of their therapist. Conclusions This study helps to better estimate aspects of negative effects in psychotherapy ranging from deteriorations, specific effects and issues of malpractice that should be replicated and specified in future studies.

Emotional experience and change in psychodynamic inpatient psychotherapy

Emotional experience and change in psychodynamic inpatient psychotherapy Objectives: The subject of the present study is the recording of emotional experience and its change through inpatient psychodynamic psychotherapy, taking into account the factors of age, gender, and traumatic experiences in childhood and adolescence. Methods: The following standardized instruments were used on the clinical sample of 971 patients (413 inpatient, 558 day clinic patients) at the beginning and at the end of the treatment: Questionnaire for the Assessment of Emotional Experience and Emotion Regulation (EER), Childhood-Trauma-Questionnaire (CTQ), Inventory of Interpersonal Problems (IIP), Helping Alliance Questionnaire (HAQ), Symptom-Check-List (SCL-90-R). Results: The mean duration of treatment was 66.8 days (SD = 14.1; range 30-96). Younger patients and polytraumatized patients showed a higher expression of negative emotions. At the end of treatment, the whole group of patients showed a change in emotional experience, especially a strong decrease in passive-negative emotions and a decrease in psychological distress. Age represented a significant factor influencing emotional change. Discussion: The results underline the importance of emotional change as a prerequisite for treatment success and confirm the effectiveness of inpatient psychodynamic treatment. A further differentiation of the patients with regard to their emotional responsiveness seems to make sense with regard to the suitability of the therapeutic offers.

The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia.

The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined. Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals. Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (μ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (μ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (β = 0.424, P < 0.001) and Personal and Social Performance scale (β = 0.272, P = 0.006), were statistically significant predictors of drug attitude. Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.

Evidence of validity of the revised Helping Alliance Questionnaire based on the internal structure in a Brazilian clinical sample.

The revised Helping Alliance Questionnaire (HAq-II) is among the most used instruments that measure therapeutic alliance. Despite its use in research, this instrument is not validated for the Brazilian population. The aim of this study was to explore the evidence of validity of the HAq-II based on the internal structure in a sample of Brazilian psychiatric patients. An ambulatory convenience sample of 204 patients with major depressive disorder (MDD) and 81 patients with obsessive-compulsive disorder (OCD) was randomized between two different types of treatment. The HAq-II was completed by patients (patient version) and by 33 therapists who performed the interventions (therapist version) between the second and third sessions. We used confirmatory factor analysis (CFA) to investigate two models: (1) a one-dimensional therapeutic alliance model and (2) a two-dimensional model considering the factors 'positive alliance' and 'negative alliance'. The internal consistency of the HAq-II was measured by Cronbach's alpha. To investigate discriminant validity, we used the t-test for independent samples, ANOVA and Pearson's correlation coefficient. The analysis showed that the best model of the instrument was one-dimensional. Cronbach's alpha for both versions displayed values above 0.89. The Brazilian version of the HAq-II presented properties similar to those found in the original version. However, studies related to the one-dimensional model with other samples are necessary.

Poster Abstracts

Purpose: There is unequivocal evidence supporting the feasibility, acceptability, and non-inferiority of evidence-based mental health (i.e., PTSD, depression, couple therapy) treatment modalities delivered via web-based telehealth (e.g., videoconferencing). However, there is a surprising scarcity of research examining telehealth delivery of evidence-based alcohol use disorder (AUD) interventions in any population. The purpose of this exploratory study is to begin to address this longstanding gap in the literature by examining the preliminary feasibility and acceptability of Alcohol Behavioral Couple Therapy (ABCT) delivered via telehealth. Method: Data were collected from participants (N = 19 couples;38 participants) who completed ABCT via telehealth as part of an ongoing randomized controlled trial during the COVID-19 pandemic. Self-report survey data were collected online via REDCap upon treatment completion (ABCT session 12). Data: Most items utilized a 5-point Likert-type scale (1 = least agreement to 5 = most agreement). Results: Findings indicate that both participants (M = 101.29, SD = 9.9) and therapists (M = 103.21, SD = 8.9) reported high therapeutic alliance as measured by the Helping Alliance Questionnaire. Participants reported a high level of positivity (M = 4.84, SD = 0.37) and comfort (M = 4.61, SD = 0.60) with telehealth delivery. The vast majority of participants (97.4%;n = 37) indicated that they would recommend telehealth to a family member or friend based on their experience with this study. Most participants reported that they perceived the same or better effectiveness of treatment via telehealth compared to in-person (84.2%, n = 32), and most found telehealth to be more convenient (84.2%, n = 32). All participants (100%) found telehealth to be equally or more accessible than in-person treatment. One participant reported that they did less homework via telehealth and just two participants reported that they dedicated less time to their treatment. Six participants (15.8%) reported that they would have preferred in-person treatment to telehealth. Findings will be updated to include participants who are and will enroll in the project in the coming months. Additional qualitative responses from participants will also be reported. Conclusions: Although preliminary, these exploratory findings highlight promising feasibility and acceptability of delivering AUD treatment to couples via home-based videoconferencing telehealth. It is important for future research to identify elements of behavioral AUD interventions that might benefit from telehealth adaptation compared to in-person treatment delivery.

Psychometric properties and longitudinal invariance of the session rating scale in Chinese clinical samples

The Session Rating Scale (SRS) is a widely used clinical tool to measure the client-therapist working alliance. This study investigated the psychometric properties, the cut-off value, and longitudinal invariance of the SRS in a Chinese clinical population. The analyses were conducted separately in a sample of college students in counseling (n = 403) and in a sample of clients in outpatient therapy (n = 246). Participants completed the Outcome Rating Scale (ORS) before each session and the SRS after each session. To test concurrent validity, a subset of participants also completed the Working Alliance Questionnaire at the end of each session. In both samples, the results indicated high internal consistency (α = .92 ~ 0.97) and adequate test-retest reliability over four sessions (university sample: r = .69 ~ .78; outpatient sample: r = .52 ~ .66). Construct validity was evident in a one-factor structure, and concurrent validity was established based on a strong correlation with the Working Alliance Questionnaire (r = .64 ~ .70). In addition, regression analysis indicated that early alliance ratings (at the third session) on the SRS predicted post-ORS scores. The cut-off value for the SRS in the Chinese context was established as 34. The longitudinal measurement invariance was tested by a longitudinal confirmatory factor analysis. Full scalar invariance of the SRS was supported. This study supported the use of the SRS in China and that a single-factor solution stayed stable over time, providing preliminary evidence for subsequent mean comparisons.

Version française de l’échelle d’alliance thérapeutique entre le supervisé et le superviseur (BSWAI-fr) : une étude pilote

Supervision in the field of behavioral and cognitive therapies has long been neglected in France. However, the little research on this subject highlights the positive effect of supervision on the psychotherapist (improvement of his skills, reduction of compassion fatigue) and on the patient (improvement of his well-being). It would seem to increase the effectiveness of therapy. The combination of supervisory work could be a major ingredient in these positive effects. Therefore, we have adapted and validated in French a 6-item tool, the Supervisory Working Alliance Questionnaire (SWAQ), to increase research on this subject and allow for a rapid and systematic evaluation of the supervisory alliance. After conducting a back-translation, we conducted an exploratory factor analysis and a confirmatory factor analysis. These analyses validate the bifactorial design of the model with “relationship” and “patient focus”. This model explains nearly 73 % of the total variance. The SMRM, TLI and CLI fit indices are very good. The analysis of the internal consistency of each subscale is excellent. One of the main limitations of this French-language validation is the population composed solely of behavioral and cognitive therapists. On the other hand, it opens up research perspectives in the little-studied field of supervision despite the obvious psychosocial risks present in psychotherapists.