Measures Of Therapeutic Relationship Research Articles

An investigation of the measurement properties of the physiotherapy therapeutic relationship measure in patients with musculoskeletal conditions

Purpose The therapeutic relationship between a patient and physiotherapist has been associated with improved physiotherapy outcomes. However, there is no agreed upon measure of therapeutic relationship in physiotherapy. This paper describes a validation study of a new patient-reported measure, the Physiotherapy Therapeutic Relationship Measure (P-TREM). Methods In this multi-site validation study, participants with musculoskeletal conditions (n = 163) completed a survey containing the P-TREM, demographic questions, a Trust in Healthcare Providers scale, and a therapeutic relationship global rating for construct validation. We investigated item quality, internal structure using exploratory factor analysis (EFA), unidimensionality, internal consistency, and construct validity. We eliminated poor performing items to optimise the length of the P-TREM. Results The final version of the P-TREM has 30 items. EFA suggests two domains: ‘Physiotherapist role’ and ‘Patient role’, correlation between factors was 0.71. Internal consistency was excellent. We found a low-moderate correlation between P-TREM scores and Trust in Healthcare Providers and a strong correlation between P-TREM scores and the therapeutic relationship global rating, confirming our hypotheses for convergent and concurrent validity. Conclusions The P-TREM can be considered for use in clinical research to understand therapeutic relationship in the care of people with longstanding musculoskeletal conditions in outpatient, in-person settings.

Attachment to the clinical team and its association with therapeutic relationships, social networks, and clinical well‐being

To determine (1) inter-relationships between social network size and quality and therapeutic relationship ratings and (2) inter-relationships between attachment style, team attachment, therapeutic relationships, social networks, and clinical and social functioning. A cross-sectional survey. A sample of 93 people using community mental health teams were assessed on their attachment status, social networks, relationship to the keyworker, attachment to the team, characteristics, and clinical and social functioning. Network size and the number friends and confidants were tested for associations with user- and professional-rated therapeutic relationship. Regression analysis was used to determine variables associated with team attachment. There was no evidence that network size or number of confidants was associated with therapeutic relationship ratings. Therapeutic relationship was strongly associated with team attachment, but of the four attachment dimensions, only preoccupied attachment was associated with team attachment. There is no evidence that therapeutic relationships are associated with the service user's 'affability' or predisposition to form relationships, suggesting that measures of therapeutic relationship and service attachment do measure something distinct about service users' experience of their care. Team attachment and therapeutic relationship measures seem likely to be measuring very similar constructs. It is possible that service users with more preoccupied attachment styles may find it particularly difficult to form positive attachments to services undergoing frequent change.

The 4-Point ordinal Alliance Self-report: a self-report questionnaire for assessing therapeutic relationships in routine mental health

Background The quality of the relationship between patient and therapist can be considered a cornerstone of psychiatric practice. Nonadherence is one of the leading problems affecting antipsychotic effectiveness in schizophrenic patients and represents a poor prognostic factor for schizophrenia. Among the factors influencing adherence, the clinician's style of communication and the therapeutic relationship (TR) are recognized as key points. The measures of TR have been broadly explored in psychotherapy process but have received little attention in the treatment of severe mental illness in the context of routine mental health. Our objective was to build a self-rating scale easy to use in clinical psychiatric practice to assess TR, including drug-taking aspects and the relationship with the clinician on a day-to-day basis. A secondary objective was to assess the scale's validity and the association between TR and adherence. Methods The study was conducted with 92 consenting inpatients who met specified criteria for schizophrenia and schizoaffective disorders ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Assessments of TR were obtained by the 4-Point ordinal Alliance Self-report and an 8-cm visual analog scale completed by the patient 1 week before discharge, after the remission of acute symptomatology. Adherence behavior was estimated with a new valid and reliable questionnaire called the Medication Adherence Rating Scale. Factor analysis was performed. Results Internal consistency was assessed by calculating Cronbach α, which revealed a highly satisfactory value ( α = .91). After oblique rotation was run, 2 understandable factors were extracted that we termed empathy experienced and psychoeducation. Conclusions Therapeutic relationship with the clinician can be considered a prerequisite for positive treatment course and outcome. The detection of subpopulations characterized by determinants of poor TR could be the first step toward improving schizophrenia prognosis linked to poor adherence.

Group Climate, Cohesion, Alliance, and Empathy in Group Psychotherapy: Multilevel Structural Equation Models.

This study examined the definitional and statistical overlap among 4 key group therapeutic relationship constructs—group climate, cohesion, alliance, and empathy—across member–member, member–group, and member–leader relationships. Three multilevel structural equation models were tested using selfreport measures completed by 662 participants from 111 counseling center and personal growth groups. As hypothesized, almost all measures of therapeutic relationship were significantly correlated. Hypothesized 1-factor, 2-factor (Working and Bonding factors), and 3-factor (Member, Leader, and Group factors) models did not fit the data adequately. An exploratory model with Bonding, Working, and Negative factors provided the best fit to the data. Group members distinguished among relationships primarily according to relationship quality rather than the status or role of others (i.e., leader, member, or whole group).