Measure Of Therapeutic Alliance Research Articles

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

AbstractPurposeThis is the second of two articles that examine the psychometric properties and treatment outcomes associated with two measures of the therapeutic alliance in naturalistic routine settings.MethodsData were taken from the ACORN database for youth, and, where available, parent/carer, attending for psychotherapy treatment in naturalistic settings (N = 12,573). 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 the two populations in routine practice.ResultsAnalyses revealed that the alliance explained no more than 3% of the variance in outcomes. Alliance measures exhibit ceiling effects, and as such, drawing conclusions about correlations with outcomes can be difficult. Any drop in alliance score as rated by both youth and parent/carer is predictive of outcomes, with parent/carer ratings being marginally more predictive. Where the alliance is rated as better by youth or parent/carer in comparison with ratings as worse, effect sizes are up to 50% better for the youth.ConclusionThe therapeutic alliance remains an important non‐specific treatment component; however, measures of the alliance have ceiling effects. Both youth and their parent/carer can provide important feedback to the therapist, and any drop in alliance is predictive of clinically meaningful change. As such, therapists should monitor the alliance with both youth and parent/carer. Implications for practice, training and research are considered.

Therapeutic alliance in individual adult psychotherapy: a systematic review of conceptualizations and measures for face-to-face- and online-psychotherapy.

The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments (n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures (n = 14), based on literature searches (n = 3) or on an empirical survey (n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.

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.

How does change occur in psychotherapy? Innovative moments predict stronger therapeutic alliance and functional improvement in a psychodynamic case study

Innovative moments (IMs) in psychotherapy contradict or challenge clients’ maladaptive patterns of meaning associated with their suffering. IMs are receiving increased theoretical and empirical attention in psychotherapy research and are associated with symptomatic improvement. However, little is known about possible predictors of IMs and their impact beyond their association with outcomes. A therapeutic alliance (TA) that implies a collaborative bond between clients and therapists might set the stage for the occurrence of IMs. Additionally, the occurrence of IMs could serve as a relational experience within the session that strengthens the TA. Thus, in the present study, we examined the association over time between IMs and (i) TA, and (ii) functioning, in a time-limited case study with a good outcome. Furthermore, this study is one of the first to explore IMs in psychodynamic therapy (PDT). Transcriptions of ten randomly selected sessions of PDT of a 43-year-old male with dysthymia were coded using the innovative moment coding system. Self-report measures of function and TA were collected at each session. Data were analyzed using simulation modeling analysis. Consistent with good-outcome cases in other therapeutic approaches, high-level IMs (H-IMs) increased while low-level IMs (L-IMs) decreased throughout treatment. H-IMs predicted a change in functioning in the following session. Finally, H-IMs were associated with higher TA post-session, and specifically with agreement on treatment tasks. To conclude, moments of change in the client’s pattern of meaning are related to stronger TA and better treatment outcome. If replicated, these findings may provide important insights regarding the unfolding of therapeutic change.

A case study of virtually delivered emotion-focused family therapy.

Clinical psychologists and therapists are increasingly taking advantage of internet and mobile-based technologies to deliver mental health services for individuals and groups since the COVID-19 pandemic. However, there is a dearth of research evaluating the appropriateness of virtual platforms for family interventions. Further, no research has examined the effectiveness of weekly emotion-focused family therapy (EFFT). This case study presents a virtually delivered 8-week EFFT intervention, which supportedcaregivers tomanagechild symptoms of depression, anxiety, and anger, facilitate emotion processing, and strengthen relationships. Two parents from one family during a marital separation participated and completed brief measures of therapeutic alliance, family functioning, parental self-efficacy, and parental and child psychological distress at 12 time points as well as a posttreatment semistructured interview. A strong therapeutic alliance was formed, and general family functioning, parental self-efficacy, parent psychopathology, and child depression, anger, and anxiety symptoms improved over the course of therapy.

Therapists' first impression of treatment motivation moderates the relationship between the client-rated therapeutic alliance and drinking outcomes during treatment.

First impressions can influence interpersonal relationships for extended periods, with negative first impressions leading to more negative judgments and behaviors between individuals months after their initial meeting. Although common factors such as therapeutic alliance (TA) are well studied, less is known of the potential influence of a therapist's first impression of their client's motivation on TA and drinking outcomes. Based on data from a prospective study of the perceptions of the TA among clients receiving cognitive-behavioral treatment (CBT), this study examined how therapists' first impressions may moderate the relationship between client-rated TA and drinking outcomes during treatment. One hundred fifty-four adults participated in a 12-week course of CBT and completed measures of TA and drinking behaviors following each treatment session. Additionally, therapists completed a measure of their first impression of their client's motivation for treatment following the first session. Time-lagged multilevel modeling revealed a significant within-person TA by therapists' first impression interaction that predicted percent days abstinent (PDA). Specifically, among participants rated as lower on first impressions of treatment motivation, higher within-person TA predicted greater PDA in the interval prior to the next treatment session. Within-person working alliance was not associated with PDA among individuals rated higher on first impressions of treatment motivation who demonstrated higher PDA throughout treatment. Furthermore, significant between-person TA by first impressions interactions were found for both PDA and drinks per drinking day (DDD), such that among individuals with lower treatment motivation, TA positively predicted PDA and negatively predicted DDD. Although therapists' first impressions of a client's treatment motivation are positively associated with treatment outcomes, clients' perception of the TA may mitigate the impact of poor first impressions. These findings highlight the need for additional nuanced examinations of the relationship between TA and treatment outcomes, emphasizing the contextual factors that influence this relationship.

Investigating the influence of interaction modality on the communication patterns of spinal cord injury peer mentors

ObjectivesTo examine how the quality of spinal cord injury peer mentorship relationships and mentor-mentee behaviors are impacted by interaction modality. MethodsUsing a within-subjects, repeated measures, experimental design, peer mentors (n = 8) completed two mentoring sessions with a standardized mentee in a telephone and a video chat condition. Measures of therapeutic alliance and autonomy supportiveness were administered following each session. Mentors’ leadership behaviors, motivational interviewing skills, and behavior change techniques were compared across conditions. Mentors’ and mentees’ use of motivational interviewing skills and behavior change techniques were further analyzed using state space grids. ResultsMentors’ therapeutic alliance, autonomy supportiveness, use of leadership behaviors, motivational interviewing skills, and behavior change techniques did not significantly differ across the two conditions (ps > 0.123; Cohen’s d range = 0.218–0.619). State space grids analyses revealed that the dynamic structure of mentoring conversations was similar when interactions occurred through the telephone versus video chat. ConclusionsMentors were effective at forming positive, autonomy supportive relationships with mentees in telephone and video chat interaction conditions. Mentors also used leadership/counselling behaviors to a similar extent when interacting through these two modalities. Practice implicationsOrganizations that provide peer mentorship can have confidence in using both telephone and video chat modalitites.

Patient-Oncologist Therapeutic Alliance Among Young Adults with Cancer: Relationships with Meaning and Peace of Mind.

Cancer diagnosis and subsequent treatment can impact how young adults make sense of their worlds and disrupt peace of mind. The patient-oncologist therapeutic alliance, built upon mutual care, respect, and trust, may foster a deeper understanding of one's illness and promote peace of mind. The study examined relationships between a comprehensive cancer-specific measure of therapeutic alliance and meaning and peace of mind among young adults with cancer (N = 56). Results indicated that a stronger therapeutic alliance was positively associated with meaning and peace of mind. Findings highlight the importance of the patient-oncologist therapeutic alliance in facilitating positive psychological outcomes among young adults with cancer.

Stronger therapeutic alliance is associated with better quality of life among patients with advanced cancer.

Patient-oncologist therapeutic alliance is a foundation of quality cancer care, although there is limited research demonstrating its relationship with patient outcomes. We investigated the relationship between therapeutic alliance and patient quality of life with a secondary goal of determining whether the association varied by patients' baseline level of psychological distress. Cross-sectional analysis of baseline data from a randomized clinical trial of 672 patients with advanced cancer participating in a primary palliative care intervention trial. Patients completed baseline self-reported measures of therapeutic alliance (The Human Connection Scale, range: 16-64), overall quality of life (Functional Assessment of Cancer Therapy-Palliative Care, range: 0-184), and psychological distress (Hospital Anxiety and Depression Scale, range: 0-42). First, we determined the relationship between therapeutic alliance and quality of life using multivariable regression adjusting for confounders. We then examined if psychological distress was an effect modifier in this relationship by adding interaction effects of depression and anxiety symptoms on therapeutic alliance into the regression model. Patients reported high levels of therapeutic alliance (56.4±7.4) and moderate quality of life (130.3±25.5). Stronger therapeutic alliance was associated with better quality of life after adjusting for other confounding factors (β=3.7, 95% confidence interval=2.1, 5.3, p<0.01). The relationship between therapeutic alliance and quality of life was generally consistent regardless of psychological distress. Collaborative, trusting relationships between patients with advanced cancer and their oncologists are associated with better patient quality of life. Future research should investigate the causal, longitudinal nature of these relationships.

Association Between Therapeutic Alliance and Outcomes Following Telephone-Delivered Exercise by a Physical Therapist for People With Knee Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial.

BackgroundThe therapeutic alliance between patients and physical therapists has been shown to influence clinical outcomes in patients with chronic low back pain when consulting in-person. However, no studies have examined whether the therapeutic alliance developed between patients with knee osteoarthritis and physical therapists during telephonic consultations influences clinical outcomes.ObjectiveThis study aims to investigate whether the therapeutic alliance between patients with knee osteoarthritis and physical therapists measured after the second consultation is associated with outcomes following telephone-delivered exercise and advice.MethodsSecondary analysis of 87 patients in the intervention arm of a randomized controlled trial allocated to receive 5 to 10 telephone consultations with one of 8 physical therapists over a period of 6 months, involving education and prescription of a strengthening and physical activity program. Separate regression models investigated the association between patient and therapist ratings of therapeutic alliance (measured after the second consultation using the Working Alliance Inventory Short Form) and outcomes (pain, function, self-efficacy, quality of life, global change, adherence to prescribed exercise, physical activity) at 6 and 12 months, with relevant covariates included.ResultsThere was some evidence of a weak association between patient ratings of the alliance and some outcomes at 6 months (improvements in average knee pain: regression coefficient −0.10, 95% CI −0.16 to −0.03; self-efficacy: 0.16, 0.04-0.28; global improvement in function: odds ratio 1.26, 95% CI 1.04-1.39, and overall improvement: odds ratio 1.26, 95% CI 1.06-1.51; but also with worsening in fear of movement: regression coefficient −0.13, 95% CI −0.23 to −0.04). In addition, there was some evidence of a weak association between patient ratings of the alliance and some outcomes at 12 months (improvements in self-efficacy: regression coefficient 0.15, 95% CI 0.03-0.27; global improvement in both function, odds ratio 1.19, 95% CI 0.03-1.37; and pain, odds ratio 1.14, 95% CI 1.01-1.30; and overall improvement: odds ratio 1.21, 95% CI 1.02-1.42). The data suggest that associations between therapist ratings of therapeutic alliance and outcomes were not strong, except for improved quality of life at 12 months (regression coefficient 0.01, 95% CI 0.0003-0.01).ConclusionsHigher patient ratings, but not higher therapist ratings, of the therapeutic alliance were weakly associated with improvements in some clinical outcomes and with worsening in one outcome. Although the findings suggest that patients who perceive a stronger alliance with their therapist may achieve better clinical outcomes, the observed relationships were generally weak and unlikely to be clinically significant. The limitations include the fact that measures of therapeutic alliance have not been validated for use in musculoskeletal physical therapy settings. There was a risk of type 1 error; however, findings were interpreted on the basis of clinical significance rather than statistical significance alone.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12616000054415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369204

Therapeutic Alliance Between Bereaved Parents and Physicians in the PICU.

Therapeutic alliance is the collaborative bond that develops between patients/families and healthcare providers. Our objective is to determine the extent of therapeutic alliance bereaved parents perceive to have occurred with their child's physicians during their child's PICU stay, and associated factors. Multicenter observational study. Eight children's hospitals affiliated with the Collaborative Pediatric Critical Care Research Network. Parents greater than or equal to 18 years old whose child died in a PICU (including cardiac ICU). Bereaved parents completed the Human Connection Scale, a 16-item measure of therapeutic alliance, 6 months after their child's death. Human Connection Scale scores range from 16 to 64 with higher scores indicating greater alliance. Parents provided sociodemographic data, and medical records were reviewed for the child's clinical characteristics. Two-hundred and thirty-three parents of 157 deceased children responded to the Human Connection Scale with greater than or equal to 80% item completion. Among parents, 146 (62.7%) were female, 155 (66.5%) were White and 46 (19.7%) were Black, 175 (75.1%) were married, and 209 (89.7%) had at least a high-school education. Among children, median age at the time of death was 5.9 years (interquartile range, 0.64-13.9 yr) and 114 (72.6%) died after limitation or withdrawal of life support. Mean Human Connection Scale score was 51.4 ± 11.1 for all parents, 52.6 ± 9.0 for White parents, and 47.0 ± 13.7 for Black parents. In multivariable modeling predicting Human Connection Scale scores, race was the only parent or child characteristic in the final model. Human Connection Scale scores were significantly different (-4.56; 95% CI, -8.53 to -0.6; p = 0.025) between the Black and White parents with items about trust, care, and honest communication showing the greatest mean difference. Among parents bereaved in the PICU, therapeutic alliance with physicians is moderately high. Future research should identify strategies to strengthen therapeutic alliance with Black parents and examine the role of alliance on bereaved parents' health outcomes.

Therapist Interruptions: An Examination of Gender and Therapeutic Alliance in Couple Therapy

Alliance is an important predictor of therapy outcomes, and studies examining in-therapy processes that contribute to alliance are needed. This study examines the relationship between interruptions and therapeutic alliance in couple therapy. First sessions of couple therapy from a university-based clinic were coded to examine the frequency of interruptions in therapy. Interruption frequency, interruption target, and subsequent measures of therapeutic alliance were examined to determine associations between those constructs. Results indicate a negative relationship between therapists interrupting men and male and female reports of alliance. Implications for therapeutic alliance and gender dynamics are discussed.

Broadening our Sight: Considering Patient-Provider Therapeutic Alliances to Improve Health Care

Two decades of research on patient experiences and patient-centered care has assumed that positive outcomes result from therapeutic alliances between patients and their professional care providers, yet therapeutic alliance has rarely been defined or measured. As more research reveals problems with patient experiences and reduced well-being among professional care providers, a closer examination of patient-provider relationships is warranted. The purpose of this qualitative study was to identify the attributes of a therapeutic alliance in health care from the patient’s perspective, then to identify quantitative measures that capture the full construct. We conducted conceptual analysis studies: (1) survey of therapeutic alliance dimensions by academic content experts (n=24); (2) two patient focus groups (n= 9; n=13); (3) a systematic review of measures of therapeutic alliance and its essential dimensions across three databases using the PRISMA guidelines. Of 2449 articles initially identified, 52 articles were retained for review after applying inclusion and exclusion criteria. Constructs measured were mapped onto the therapeutic alliance dimensions derived from this study’s preceding qualitative work. Analysis found no measures that captured all of the therapeutic alliance dimensions. “Shared Mind” was the most frequently measured construct (n=27 unique measures). “Full Presence/Authenticity” was identified by patients and content experts as being key for strong alliances, yet there was little published research on this construct. Broadening our sight for better health care necessitates considering the core patient-provider relationship and how it impacts both patient and care provider outcomes.

A Substance Use Treatment Programme for Mentally Ill Forensic Patients in an Australian Setting: A Pilot Study of Feasibility, Acceptability and Preliminary Efficacy

This study aims to evaluate the feasibility, acceptability and preliminary efficacy of an Australian-adapted Substance Use Treatment Programme (SUTP) among mentally ill offenders in an Australian secure forensic setting. A single-group non-controlled pilot trial was conducted. Four SUTP treatment groups were run simultaneously (n = 39) with sessions held weekly over 12 weeks. Feasibility was assessed by examining attrition, study retention and motivation for treatment, and measures of therapeutic alliance, client satisfaction and qualitative interviews were used to determine acceptability. Preliminary efficacy was assessed using self-report questionnaires implemented at baseline and post-intervention measuring drug related locus of control, confidence to resist substances in the future and beliefs about substance use. Low attrition, high levels of satisfaction and moderately positive levels of therapeutic alliance were found. Participants also demonstrated a significant shift towards an internal drug related locus of control upon completion of SUTP. SUTP is a promising intervention for mentally ill offenders with a history of substance use in Australian forensic services. A randomised controlled trial is warranted to rigorously evaluate the efficacy of SUTP in this setting.

The Psychometric Properties of the Session Rating Scale: A Narrative Review

ABSTRACTBackground: The Session Rating Scale (SRS) is a measure used in psychotherapy practice. Given its application and frequent use in clinical practice settings, several studies including primary validation studies as well as outcome studies reporting psychometric properties have examined the validity and reliability of the SRS. Because the SRS is designed to be used in clinical practice, demonstration of reliability and validity is ideal with clinical populations instead of non-clinical populations. To our knowledge, there have been no reviews evaluating the psychometric properties of the SRS with clinical populations.Purpose: The aim of this study was to review and synthesize the psychometric properties of the SRS by examining all relevant outcome and validation studies.Methods: We completed an electronic literature search of several online databases in order to identify relevant articles. We identified 12 articles that met our inclusion and analyzed the reliability and validity evidence for the SRS with clinical populations.Results: Findings showed high internal consistency for the SRS and support evidence that the underlying dimension is a measure of therapeutic alliance. Test–retest reliability estimates were reported in 4 of the 12 studies included in this review (ranging from .54 to .70). The SRS had low to moderate concurrent validity with other longer measures of therapeutic alliance (.29 with ORS; .48 with HAQ II; .57-.65 with WAI).Discussion: Clinicians should be aware of the limitations in validity evidence for the SRS that may result from its brevity. However, clinicians should also consider the relative stability of the SRS as a pragmatic global measure of the construct of therapeutic alliance. Future research efforts should focus on validation of the SRS with larger, more diverse samples and specific clinical populations with a wider range of symptom severity.

Perspectiva del terapeuta acerca de la negociación de la alianza: Un instrumento para su evaluación

Alliance negotiation is defined as the patient and therapist’s ability to solve relational problems and disagreements (in therapeutic goals and tasks) during therapy. Although this construct is essentially a dyadic notion, with important clinical implication for treatments of different theoretical frameworks, currently there is only one instrument that can measure alliance negotiation and it is only based on the patients’ perspective about therapy. The aim of this paper is to develop and examine the preliminary psychometric properties of the Alliance Negotiation Scale, therapist form. In the context of the importance attributed to analyzing relational constructs with a dyadic perspective, this instrument will not only allow to measure the perception of alliance negotiation from therapist’s point of view, but also it will provide the necessary information to have a dyadic measurement of alliance negotiation by using both the original Alliance Negotiation Scale and the Alliance Negotiation Scale, therapist form in the same cases. With this purpose, a sample of 188 therapists from different theoretical frameworks completed an initial pool of twenty four preliminary items of the Alliance Negotiation Scale, therapist form. All the items of Alliance Negotiation Scale, therapist form, were developed based on the original Alliance Negotiation Scale, adapted to be completed by the therapist, and scored in a seven point Likert scale ranging from 1 (Never) to 7 (Always). The sample of therapist also completed the Working Alliance Inventory, therapist from, a widely spread standard measure of therapeutic alliance. For both instruments we asked the therapist to answer the measures thinking about a patient they have recently treated. To avoid a bias in patients’ selection and ceiling effects in alliance scores, half of the sample of therapists was randomized to use as a reference a patient they considered easy, while the other half was asked to select a difficult patient. For data analyzes we first ran a principal component analysis in order to find the best factorial solution for the items and to establish the construct validity of the scale. Based on that factorial solution we analyzed the internal consistency of the final version of the Alliance Negotiation Scale, therapist form, using Cronbach’s alphas coefficients and item’s homogeneity using adjusted item-total correlations. Finally, to test for criterion validity we explored the associations between the Alliance Negotiation Scale, therapist form, and the Working Alliance Inventory, therapist from, using Pearson’s correlations. The principal component analysis suggested a one-dimensional solution integrated by nine items, explaining a 42.16 % of the total variance. All the items in this solution had factorial weights above .40. Furthermore, the analysis of reliability on this version of the scale showed an adequate internal consistency (Cronbach’s a = .82). The adjusted item-total correlations presented also evidences of homogeneity ( r ’s range: between .34 and .66), suggesting that all the items explores different aspects from a common construct, without being redundant. Finally, the correlations between the Alliance Negotiation Scale, therapist form, and the Working Alliance Inventory, therapist from, presented evidences of criterion validity ( r with WAI: .51, p < .001). This result showed an association between the measures but also indicate that they do not measure the exact some construct. The specific characteristics and properties of the Working Alliance Inventory, therapist from, presented in this paper, suggested that this measure represents an important contribution both for clinical practice and research. Future studies will need to further explore and confirm the psychometric properties of the Working Alliance Inventory, therapist from, and analyze its application for dyadic measures of the therapeutic alliance negotiation in psychotherapy.

Measuring therapeutic alliance in children with autism during cognitive behavior therapy.

Therapeutic alliance (TA), or the collaborative relationship between a therapist and client, has been shown to be an important component of intervention success. The objective of this study was to examine the psychometric properties of the Therapy Process Observational Coding System-Alliance Scale (TPOCS-A). The sample consisted of 20 children (19 males) ages 8 to 12 years with autism and their parents (15 mothers, 5 fathers), who completed a cognitive-behavioural intervention designed to improve children's emotion regulation skills. Two trained coders rated early, middle, and late parent and child alliance using the TPOCS-A after watching video recorded therapy sessions. Therapist-reported child involvement, alliance, and adherence were also assessed. Psychometric findings revealed that the TPOCS-A is a reliable and valid measure of therapeutic alliance for children with autism. The implications of examining TA in empirically supported treatments for this population are discussed.

Assisted outpatient treatment orders and the therapeutic relationship in Assertive Community Treatment: a mixed-methods study

ABSTRACTBackground: A large proportion of clients served by Assertive Community Treatment (ACT) teams in New York City (NYC) are referred through “Assisted Outpatient Treatment” (AOT), which involves civil commitment to outpatient services. Research indicates that clients perceive AOT to be coercive, but it is unclear how this impacts the therapeutic relationships with ACT teams. We used mixed-methods to examine and compare perceptions of the therapeutic relationship and associated factors between ACT clients who were, and were not, referred through AOT.Method: Thirty persons receiving ACT services in NYC (15 AOT, 15 non-AOT) completed qualitative interviews about perceptions of treatment and referral, as well as measures of therapeutic alliance, procedural fairness, experienced coercion, shared decision-making, and self-stigma.Results: Quantitative findings revealed no differences in measures between AOT and non-AOT participants, with the exception being perception of “negative pressures” in the referral process, which was higher in the AOT group. However, qualitative findings were more mixed, with a notable subgroup of AOT-participants endorsing themes of paternalism and coercion in the referral and treatment decision-making process.Discussion: Findings indicate that the impact of AOT-referral on perceptions of ACT services is complex, and that AOT referrals impact treatment relationships in a subset of clients.

Aphasia and stroke therapeutic alliance measure (A-STAM): Development and preliminary psychometric evaluation

Purpose: The therapeutic alliance, also known as the therapeutic relationship, may influence treatment process and outcome in aphasia rehabilitation; however, we currently lack a reliable tool to measure this relationship. This study aimed to develop a novel measure of the therapeutic alliance applicable to this population and provide preliminary evidence of the measure’s psychometric properties.Method: Statements were generated from the: (1) therapeutic alliance literature, (2) qualitative interviews with stakeholders, and (3) Q methodological insights with people with aphasia (PWA) (n = 455). A representative sample of statements was identified from the data set (n = 57) and reviewed by expert panels (professionals and PWA), culminating in a 42-item clinician and patient version of the aphasia and stroke therapeutic alliance measure (A-STAM). Reliability and validity of both the clinician and patient versions of A-STAM were investigated with 34 Clinician-patient dyads engaging in therapy.Result: Internal consistency and test–retest reliability were excellent for both clinician (α = 92; ICC = 0.93) and patient versions of A-STAM (α = 0.92; ICC = 0.97). In both versions, scores correlated highly with psychotherapeutic measures of therapeutic alliance, indicative of good construct validity (rs = 0.75; rs = 0.77).Conclusion: The findings establish the preliminary reliability and validity of A-STAM and support further investigation into the measure’s psychometric properties in larger samples.

Evaluating an Internet-based video cognitive processing therapy intervention for veterans with PTSD: A pilot study

Introduction There remain a number of UK military veterans who are not able to access psychological therapies for post-traumatic stress disorder (PTSD). Some of these barriers are practical, including the need to balance work and other life commitments with attendance at residential or outpatient appointments. There is a need to investigate more accessible and flexible methods of delivering psychological therapies to veterans. One such alternative is to use remote-access video technology, often referred to as tele-therapy. The aims of the present study were to explore the feasibility of using tele-therapy in this population, whilst also reporting mental health outcomes for those who accessed the intervention. Methods Participants were recruited from a UK veterans mental health charity. The intervention consisted of 12 sessions of cognitive processing therapy delivered via Skype. Participants completed various measures of mental health, including PTSD at three time points: pre-treatment, post-treatment and at three months follow-up. A measure of therapeutic alliance was also completed by participants and the clinician. Results A total of 27 participants engaged in tele-therapy, with a treatment completion rate of 79% and a ‘did not attend’ rate of 12%, which compared well against similar outpatient services. All mental health outcomes showed maintained improvement at three months follow-up, with the highest effect size recorded for PTSD. Therapeutic alliance was also rated highly by both participants and the clinician. Discussion The findings suggest that tele-therapy could provide a viable alternative format for delivering trauma-focused psychological therapies to veterans. Limitations and recommendations for future research are also presented.