Working Alliance Inventory Research Articles

Can session-by-session changes in self-reported alliance scores serve as a measure of ruptures in the therapeutic alliance?

During treatment, the therapeutic alliance is characterized by rupture and repair episodes, which in turn are associated with psychotherapy outcome. It would be important to have a parsimonious tool to identify ruptures in psychotherapy sessions to provide therapists with meaningful feedback about when they occur. The present study thus aims to establish whether measuring self-reported alliance dynamics can function as a measure of alliance ruptures. The sample consisted of 58 depressed patients, who received 22 sessions of cognitive therapy for depression in an outpatient setting. The observer-rated Rupture Resolution Rating System (3RS) was applied to 58 sessions where the self-reported Working Alliance Inventory (WAI) completed by patients after each therapy session indicated that alliance ratings declined more than 2 SDs from that patient's individual mean. For comparison purposes, the 3RS was also applied to 58 randomly chosen sessions from the same treatment phase (early, middle, late). Results showed significant differences between sessions where the WAI indicated a drop in the alliance and randomly chosen sessions of the same treatment phase with regard to the frequency and impact of ruptures. This speaks for the construct validity of the 3RS. Session-by-session alliance ruptures may reliably be measured using a case-sensitive approach to identify meaningful drops in alliance self-report (WAI). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Translation of the working alliance inventory short revised into Italian using a Delphi procedure and a forward-backward translation.

Enhancing treatment adherence, especially for chronic diseases, can be achieved through therapeutic alliance, potentially elevating the quality of care. An instrument to evaluate the therapeutic alliance could be beneficial in routine clinical settings, educational environments, and extensive research efforts at national and European levels. In this study, we translated therapist and patient versions of the Working Alliance Inventory Short Revised (WAI-SR) into Italian. An email-based Delphi method was employed for the English-to-Italian translation, incorporating a forward-backward process. The initial translation team comprised two Italian family physicians proficient in English, a linguist, and a psychiatrist. The forward translation was then reviewed by 18 Italian family physicians through a Delphi process and was subjected to a backward translation by two Italian English teachers. A cultural correspondence was subsequently identified to adjust translations within a national and international framework. All 18 experts fully engaged in the Delphi process, and consensus was achieved by the second Delphi round. A cultural check checked for discrepancies regarding linguistic consistency with other translations and found no difference. This Italian translation of the WAI-SR is expected to support Italian family physicians aiming to enhance their clinical practice and therapeutic outcomes. It could also be a valuable tool for Italian medical students to foster therapeutic relationships and improve their communication skills.

Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder

ABSTRACT Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes. Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP. Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised. Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity. Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary. Trial registration: ClinicalTrials.gov identifier: NCT00090064.

The Impact of Relationship on Goal Attainment in a Home-Based Family Support Program

Home-based family support programs provide early intervention to support families with young children. Home visiting models typically serve pregnant and parenting women with risk factors known to influence the caregiver-child relationship including history of trauma, low academic achievement, low income, limited support networks, maternal depression, and maternal substance use. Few, if any, home visiting models, however, were developed specifically to support families affected by maternal substance use. The Team for Infants Exposed to Substance use (TIES) Program is a home-based family support program exclusively serving families affected by maternal substance use. The model design and intensive services allow TIES participants to achieve significant positive outcomes in the program’s six goal areas: maternal substance use, parenting skills, child mental and physical health, maternal mental and physical health, family income, and family housing. Goal scores are assessed jointly by participants and staff throughout the program using a validated scale. Program staff hypothesize that goal attainment in these areas may be influenced by the therapeutic relationship developed between home visitors and participants. This relationship is assessed using the Working Alliance Inventory (WAI), a validated assessment of therapeutic alliance administered to both participants and staff. An analysis of 127 program participants shows that when controlling for home visitor WAI scores in multilevel models (MLMs), goal attainment scores improved from intake to discharge across all goal areas except for housing stability. These results stress the importance of the therapeutic relationship in maximizing TIES participants’ growth and success.

Working alliance in treating staff and patients with Schizophrenia Spectrum Disorder living in Residential Facilities.

Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies. Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI-P) and staff members (WAI-T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning. Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI-P and WAI-T ratings. Linear regression showed that patients with higher education reported lower WAI-P ratings (β = -.50, p = .044), while not being engaged in work or study was associated with lower WAI-T scores (β = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI-P ratings (β = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI-T (β = -.10, p = .002) and WAI-P ratings (β = -.19, p < .001). Better functioning level positively foresaw WAI-T (β = .14, p < .001) and WAI-P ratings (β = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy. This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.

Characterizing the research mentorship experience of genetic counseling students.

The Accreditation Council for Genetic Counseling's Practice-Based Competencies include research-related skills, which are taught in master's level genetic counseling programs through didactic coursework and completion of mentored research experiences. It is known that research mentors can impact student work environments, create positive perceptions of the research process, and increase students' likelihood of future involvement in research. However, few studies have characterized the experiences of GC students in receiving research mentorship. It is crucial to understand these experiences from student perspectives to better inform stakeholders about factors that impact mentorship. Using a mixed-methods approach, this study explored GC students' experiences receiving research mentorship and their thoughts regarding the successful qualities of research mentors. GC students (N = 165) who graduated between 2019 and 2022 responded to an online survey measuring the mentorship relationship, defined by the Advisory Working Alliance Inventory (AWAI). On average, participants scored 3.96/5 on the AWAI, where higher scores indicate stronger working alliances. When asked to describe their overall research experience in three words, 75.7% of participants used at least one negatively connotated descriptor. Thematic analysis of semi-structured interviews obtained via purposive sampling of highest and lowest scoring participants on the AWAI (N = 14) revealed the following five themes related to successful qualities of a research mentor: (1) communication; (2) rapport building and relationship; (3) engagement and guidance; (4) expertise and connections; and (5) mentors with different roles. Of note, many of these qualities are foundational skills in genetic counseling. Thus, genetic counselors who may be strong in these areas who do not identify as "researchers" ought to consider becoming a research committee member. Additionally, education programs could consider implementing research committee member evaluations and/or student research self-efficacy surveys to evaluate how these relationships may be shaping research experiences for students within their program.

The connection still matters: Therapeutic alliance with digital treatment for alcohol use disorder.

A strong cooperative bond between the patient and provider ("therapeutic alliance") is robustly associated with better alcohol use disorder (AUD) treatment outcomes. Although digital treatments for AUD have significant potential, the function of the alliance during digital programs is unclear. We compared the validity of patient-reported measures of the alliance with a digital treatment ("digital alliance") for AUD and the alliance with their clinician ("clinician alliance"). We used data from an 8-week, randomized clinical trial of a computerized cognitive behavioral therapy program (CBT4CBT) during outpatient AUD treatment. Treatment conditions included CBT4CBT with minimal clinical monitoring (CBT4CBT + monitor) or with treatment as usual (CBT4CBT + TAU). The digital alliance and clinician alliance were measured with similar versions of the Working Alliance Inventory (WAI). The WAI ratings were completed at the 2nd and 6th treatment sessions. A timeline followback calendar assessed daily alcohol use. Bayesian multilevel models compared the strength of the alliances and tested their associations with future alcohol use. Data from 43 participants were included (age M = 44; 65% male; 51% Black, 40% White, 9% other; 14% Hispanic). The digital alliance ratings had similar internal reliability as the clinician alliance ratings (ω's > 0.90). Differences between digital alliance and clinician alliance ratings were negligible in both treatment conditions (BF01 = 9 and 31). During treatment, within-person increases in the digital alliance and the clinician alliance predicted modest decreases in future drinking to a similar degree (BF01 = 15). Alliance ratings were not associated with future drinking when posttreatment follow-up drinking data were included (BF10 < 3). The digital alliance with CBT4CBT was comparable to the clinician alliance. The digital alliance and clinician alliance had similar, albeit very small, associations with abstinence during treatment. Future research can explore how the digital alliance develops to improve AUD treatment efficacy.

Data mining techniques in psychotherapy: applications for studying therapeutic alliance

Therapeutic Alliance (TA) has been consistently reported as a robust predictor of therapy outcomes and is one of the most investigated therapy relational factors. Research on therapists' and clients’ contributions to the alliance development and the alliance-outcome relationship had shown mixed results. The relation of the therapist’s and client’s biological markers with the alliance is an important and under-investigated topic. Taking advantage of data mining techniques, this exploratory study aimed to investigate the role of different therapist and client factors, including heart rate (HR) and electrodermal activity (EDA), in relation to TA. Twenty-two dyads with 6 therapists and 22 clients participated in the study. The Working Alliance Inventory (WAI) was used to evaluate the client’s and therapist's perception of the alliance at the end of each session and through the therapy processes. The Cross-Industry Standard Process for Data Mining (CRISP-DM) was used to explore patterns that may contribute to TA. Machine Learning (ML) models have been employed to provide insights into the predictors and correlates of TA. Our results showed that Linear Regression (LR) was the best technique for predicting the therapist’s TA, with client “Diagnostic” and therapy “Termination” being identified as significant predictors of the therapist’s TA. In addition, for clients’ TA, the Random Forest (RF) was shown to have the best performance. The therapist’s TA and therapy “Outcome” were observed as the most influential predictors for the client’s TA. In addition, while the Heart Rate (therapist) was negatively associated with the therapist’s TA, EDA in the client was a physiological indicator related to the client’s TA. Overall, these findings can assist in identifying key factors that therapists should focus on to enhance the quality of therapeutic alliance. Results are discussed in terms of their consistency with empirical literature, innovative and interdisciplinary research on the therapeutic alliance field, and, in particular, the use of the Data Mining approach in a psychotherapy context.

Therapeutic Alliance: Associations with Childhood Trauma and Parental Bonding

Literature has shown the importance of therapeutic alliance in the psychotherapeutic process and seeks to understand factors that can interfere in its establishment, such as childhood trauma and parental bonding. As such, this study aims to evaluate therapeutic alliance in psychodynamic psychotherapy from the perspective of adult patients and the correlation between parental bonding and childhood trauma. A cross‐sectional and correlational study was carried out with 180 adult patients who started psychodynamic psychotherapy between May 2015 and May 2016 in a mental health clinic whereby Working Alliance Inventory, Parental Bonding Instrument and Childhood Trauma Questionnaire tools were used. The results show that there are correlations between the father's care and total alliance, as well as the dimensions of goal and bond, but those with mother did not reach statistical significance. The dimensions of emotional abuse and emotional neglect show an inverse correlation with the therapeutic alliance. These results point to the importance of experience of early relationships in establishing therapeutic alliance, relevance of the father figure in this process, and the need for clinicians to be aware of these attachment factors and patient childhood traumas to establish a strong therapeutic relationship.

The Influence of Personality Type on Patient Outcome Measures and Therapeutic Alliance in Patients with Low Back Pain.

Low back pain (LBP) has been shown to have various biological, psychological, and social factors that affect prognosis. However, it is unclear how personality may influence self-reported outcome measures and therapeutic alliance (TA). Eysenck's personality inventory was used to assess personality, while the numeric pain rating scale (NPRS), Oswestry Disability Index (ODI), Tampa Scale of Kinesiophobia (TSK), Global Rating of Change (GROC), and the Working Alliance Inventory (WAI) measured patient progress and relationship strength. All outcome measures were formulated in a single survey that both the therapist and patient completed electronically. Sixty-seven patients with LBP and twenty-two licensed physical therapists participated. For personality measures, there was a significant positive correlation between neuroticism and GROC (rho = 0.295, p = 0.015) and a significant negative correlation between extraversion and WAI (rho = -0.243, p = 0.048). Significant correlations were found between ODI and TSK (rho = 0.462, p ≤ 0.001) and between ODI and GROC (rho = -0.416, p ≤ 0.001). A significant negative correlation was found between TSK and GROC (rho = -0.301, p = 0.013). Patients with higher levels of disability seemed to report higher levels of kinesiophobia and less overall improvement in physical therapy. Patients classified as neurotic reported higher levels of improvement while extraverted patients demonstrated a weaker therapeutic alliance with their therapist.

The real relationship: the Portuguese version of the Real Relationship Inventory-Client form.

The Real Relationship is a relational construct that has influenced other constructs, like the working alliance, although empirically neglected. The development of the Real Relationship Inventory provides a reliable and valid way of measuring the Real Relationship in research and clinical applications. This study aimed to validate and explore the psychometric properties of the Real Relationship Inventory Client Form with a Portuguese adult sample in the context of psychotherapy. The sample includes 373 clients currently in psychotherapy or concluded recently. All clients completed the Real Relationship Inventory (RRI-C) and the Working Alliance Inventory. The confirmatory analysis revealed the same two factors in the RRI-C for the Portuguese adult population, Genuineness and Realism. The observation of the same factor structure suggests the cross-cultural value of the Real Relationship. The measure demonstrated good internal consistency and acceptable adjustment. A significant correlation was found between the RRI-C and the Working Alliance Inventory and significant correlations between the Bond and Genuineness and Realism subscales. The present study reflects on the RRI-C while also contributing to the importance of the Real Relationship in different cultures and clinical contexts.

Randomized trial of brief interpersonal psychotherapy and cognitive behavioral therapy for depression delivered both in-person and by telehealth

BackgroundExpert consensus guidelines recommend Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT), interventions that were historically delivered face-to-face, as first-line treatments for Major Depressive Disorder (MDD). Despite the ubiquity of telehealth following the COVID-19 pandemic, little is known about differential outcomes with CBT versus IPT delivered in-person (IP) or via telehealth (TH) or whether working alliance is affected. MethodsAdults meeting DSM-5 criteria for MDD were randomly assigned to either 8 sessions of IPT or CBT (group). Mid-trial, COVID-19 forced a change of therapy delivery from IP to TH (study phase). We compared changes in Hamilton Rating Scale for Depression (HRSD-17) and Working Alliance Inventory (WAI) scores for individuals by group and phase: CBT-IP (n = 24), CBT-TH (n = 11), IPT-IP (n = 25) and IPT-TH (n = 17). ResultsHRSD-17 scores declined significantly from pre to post treatment (pre: M = 17.7, SD = 4.4 vs. post: M = 11.7, SD = 5.9; p < .001; d = 1.45) without significant group or phase effects. WAI scores did not differ by group or phase. Number of completed therapy sessions was greater for TH (M = 7.8, SD = 1.2) relative to IP (M = 7.2, SD = 1.6) (Mann-Whitney U = 387.50, z = −2.24, p = .025). LimitationsParticipants were not randomly assigned to IP versus TH. Sample size is small. ConclusionsThis study provides preliminary evidence supporting the efficacy of both brief IPT and CBT, delivered by either TH or IP, for depression. It showed that working alliance is preserved in TH, and delivery via TH may improve therapy adherence. Prospective, randomized controlled trials are needed to definitively test efficacy of brief IPT and CBT delivered via TH versus IP.

The Risk, Need, and Responsivity Relevance of Working Alliance in a Sexual Offense Treatment Program: Its Intersection With Psychopathy, Diversity, and Treatment Change.

The current study examined the self-reported working alliance of men attending a high intensity sexual offense treatment program and its associations with psychopathy, sexual violence risk, treatment change, and recidivism, in a Canadian sample of 317 incarcerated men followed up an average of approximately 10 years post release. Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) self-reported total, Task, Bond, and Goal scores were positively correlated with treatment related changes in risk, and inversely associated with Psychopathy Checklist-Revised (PCL-R; Hare, 1991; Wang & Hare, 2003) scores. The Affective facet of the PCL-R, representing the callous-unemotional features of the syndrome, uniquely predicted lower Bond and Goal scores controlling for the other facets. Cox regression survival analyses demonstrated that sexual violence risk predicted increased sexual recidivism while change predicted decreased sexual recidivism controlling for PCL-R total score; however, WAI scores (particularly the Goal component) were also unexpectedly associated with increased sexual recidivism. For violent recidivism, psychopathy, risk, and change incremented the prediction of general violence, while the WAI was not significantly associated with this outcome. A set of parallel analyses, stratified by Indigenous ethnocultural heritage, demonstrated some continuity, but also potential areas of difference, in substantive findings. Risk, need, responsivity implications of the working alliance for the treatment of high psychopathy correctional clientele, and how this may intersect with Indigenous heritage, are discussed.

Physiological and neural synchrony in emotional and neutral stimulus processing: A study protocol.

As psychotherapy involves at least two individuals, it is essential to include the interaction perspective research. During interaction, synchrony, i.e., the occurrence of simultaneous responses, can be observed at the physiological, neural, and behavioral level. Physiological responses include heart rate and electrodermal activity; neural markers can be measured using electroencephalogram. Emotionally arousing stimuli are allocated more attentional resources (motivated attention), which is reflected in physiological activation and brain potentials. Here we present a protocol for a pilot study implementing a new research methodology, and replication of the motivated attention to emotion effect in in dyads. There is evidence that higher synchrony is associated with more positive (therapeutic) relationships. Thus, the secondary outcome will be the association between physiological and neural synchrony and subjective ratings. Individuals (18-30 years) will participate in same-sex pairs in two experiments. In the first experiment (triadic interaction), both participants attentively watch unpleasant, neutral and pleasant pictures, and read/listen to standardized scripts (unpleasant, neutral, and pleasant, respectively) for the imagination task. In the second experiment, participants will read out three scripts (unpleasant, neutral, pleasant) to each other, followed by a joint imagination period. Stimuli will be presented in counterbalanced orders. After each picture and imagination, participants rate their subjective arousal and valence. In the beginning and in the end of the procedure, dyads rate their relationship, sympathy, and bonds (Working Alliance Inventory subscale). Heart rate, electrodermal activity and electroencephalogram will be continuously measured during both experiments using portable devices (EcgMove4 and EdaMove4, nine-channel B-Alert X-Series mobile-wireless EEG). Synchrony analyses will include the dual electroencephalography analysis pipeline, correlational analyses and Actor-Partner Interdependence Models. The present study protocol provides an experimental approach to investigate interpersonal synchrony during emotion processing, allowing for the establishment of research methods in a pilot study, which can later be translated into real-life psychotherapy research. In the future, fundamental understanding of such mechanisms in dyadic interactions is essential in order to promote therapeutic relationships, and thus, treatment effectiveness and efficiency.

Exploring how informed mental health app selection may impact user engagement and satisfaction.

The prevalence of mental health app use by people suffering from mental health disorders is rapidly growing. The integration of mental health apps shows promise in increasing the accessibility and quality of treatment. However, a lack of continued engagement is one of the significant challenges of such implementation. In response, the M-health Index and Navigation Database (MIND)- derived from the American Psychiatric Association's app evaluation framework- was created to support patient autonomy and enhance engagement. This study aimed to identify factors influencing engagement with mental health apps and explore how MIND may affect user engagement around selected apps. We conducted a longitudinal online survey over six weeks after participants were instructed to find mental health apps using MIND. The survey included demographic information, technology usage, access to healthcare, app selection information, System Usability Scale, the Digital Working Alliance Inventory, and the General Self-Efficacy Scale questions. Quantitative analysis was performed to analyze the data. A total of 321 surveys were completed (178 at the initial, 90 at the 2-week mark, and 53 at the 6-week mark). The most influential factors when choosing mental health apps included cost (76%), condition supported by the app (59%), and app features offered (51%), while privacy and clinical foundation to support app claims were among the least selected filters. The top ten apps selected by participants were analyzed for engagement. Rates of engagement among the top-ten apps decreased by 43% from the initial to week two and 22% from week two to week six on average. In the context of overall low engagement with mental health apps, implementation of mental health app databases like MIND can play an essential role in maintaining higher engagement and satisfaction. Together, this study offers early data on how educational approaches like MIND may help bolster mental health apps engagement.

Investigating Reliability, Validity, and Measurement Invariance of the Eight-Item Vocational Rehabilitation Engagement Scale With a Sample of Multilingual Clients

Background: Vocational rehabilitation (VR) engagement is a vital component for successful rehabilitation outcomes. Purpose: The purpose of this study is threefold: First, we investigated the item clarity of the Vocational Rehabilitation Engagement Scale (VRES); second, we explored the factorial structure; third, we examined the measurement invariance of the VRES across gender and education level for culturally diverse and bilingual clients in public VR program (i.e., clients speak English as a second language). Given the positive effects of client engagement in health and rehabilitative care on outcomes, it is important to validate this brief instrument to measure VR engagement for culturally diverse and bilingual clients. Method: Data, collected from 16 VR clients who completed the original VRES in the focus group, were subjected to content analysis, and data, collected from 264 clients who completed the eight-item VRES and Working Alliance Inventory Short Form (WAI-S), were subjected to confirmatory and multigroup confirmatory factor analysis (MGCFA). Results: Based on the feedback from the focus group, the first item was revised to increase clarity. However, the preliminary results indicated that the revised item had very low community value, and therefore, we removed the item from the subsequent analysis. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) results provided support for a unidimensional structure for the eight-item VRES. Measurement invariance across gender and education level was achieved after correlating error terms. The scale had strong reliability, and scores from the VRES were significantly moderately correlated with working alliance. Conclusion: The eight-item VRES is a reliable and valid measurement tool to use with culturally diverse and multilingual participants.

The development of a Brief Working Alliance Inventory for clients and therapists using multilevel factor analysis and item response theory in the United States and China.

This study aimed to investigate the multilevel factor structure of the therapist and client versions of the 12-item Working Alliance Inventory-Short Revised (WAI; Hatcher & Gillaspy, 2006) in the United States and China, and to create a three-item brief version (WAI-B3) using multilevel factor analysis (M-FA) and multilevel item response theory (M-IRT). We gathered eight data sets from two samples each in United States and China with a total of 21,623 sessions from 376 therapists and 2,455 clients. M-FA results with the first four data sets (two American and two Chinese) suggested that the 12-item WAI across therapist and client versions, and in both United States and China showed a dominant general WA factor with three specific subgroup factors corresponding to the Goal, Task, and Bond items. We then constructed a three-item WAI-B3 by selecting items 11, 10, and 9 through M-IRT, as the best representative of Goal, Task, and Bond subscales, respectively, for both the therapist and client versions in United States and China. With the other four data sets (two American, two Chinese) to test the WAI-B3, we found adequate multilevel reliability, structural validity, and convergent validity with the original 12-item WAI scores. Multilevel measurement invariance tests provided tentative and mixed support for the equivalence of WAI-B3 between the American and Chinese data sets and between therapist and client versions. We recommend that the WAI-B3 be used in routine clinical practice to track therapy process, and that the WAI-B3 be tested with other client and therapist populations and cultures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Creating a brief form of the Supervisory Working Alliance Inventory in the Chinese cultural context using multilevel factor analyses.

The aim of this study was to examine the multilevel factor structure of the Supervisory Working Alliance Inventory (SWAI; Efstation et al., 1990) and shorten it for routine clinical use in the Chinese cultural context. Participants were 203 (Sample 1) and 97 (Sample 2) beginning counseling trainees from a master's level training program in China. They were given the SWAI after every supervision session, and a subset of Sample 1 trainees also completed measures of their counseling self-efficacy before every client session. With Sample 1, multilevel exploratory factory analysis (M-EFA) showed that for the original 19-item version of SWAI, two factors emerged on the within-trainee level (Rapport and Client Focus) as proposed in Efstation et al. (1990), whereas only one General Alliance factor was identifiable on the between-trainee level. After removing poorly or double-loaded items, a six-item brief version of SWAI (SWAI-Brief) was obtained. Using Sample 2, multilevel confirmatory factor analysis and multilevel bifactor models supported the factor structure found in M-EFA with Sample 1. Empirical evidence also supported the reliability of the SWAI-Brief, as well as its criterion-related concurrent and predictive validity given its significant associations with trainee's counseling self-efficacy at the same week and in the subsequent week. Results suggested that the six-item SWAI-Brief could be a reliable and valid measure for assessing supervisory working alliance in the Chinese cultural context and may be used to continuously track clinical supervision processes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patient-physician alliance and patient’s sense of self-efficacy are negatively associated with resistance to treatment among patients with type 2 diabetes

AimsResistance to treatment is prevalent among patients diagnosed with chronic conditions, including type 2 diabetes (T2DM). The current study aimed to examine the relationship between patient characteristics, patient-physician relationship, and resistance to treatment in T2DM. MethodsA sample of 120 T2DM patients were recruited by means of non-randomized sampling and through a public post on Facebook. Participants were asked to fill-in several questionnaires online: Rotter’s Locus of Control questionnaire (short version); the General Self-efficacy (GSE) questionnaire; the Working Alliance Inventory - Short Revised (WAI-SR) - evaluating patient-physician relationship; and, finally, the Resistance to Treatment Questionnaire (RTQ) - which meant to capture the intensity of resistance to treatment and served as the dependent variable in this study. ResultsInterestingly, better patient-physician relationship and higher sense of self-efficacy among patients were found to negatively associate with patient’s resistance to treatment (r = −.53, p < .001, and, r = −.26, p < .01, respectively). Patient-physician relationship explained 22% of the variance of resistance to treatment, and self-efficacy explained 6% of the variance. ConclusionsStronger patient-doctor relationship and higher sense of self-efficacy are shown to robustly associate with lower resistance to treatment among patients with T2DM. Current findings may instructor educate physicians as to the importance of the alliance with these chronic patients.

Digital Phenotyping Data to Predict Symptom Improvement and Mental Health App Personalization in College Students: Prospective Validation of a Predictive Model.

Mental health apps offer a transformative means to increase access to scalable evidence-based care for college students. Yet low rates of engagement currently preclude the effectiveness of these apps. One promising solution is to make these apps more responsive and personalized through digital phenotyping methods able to predict symptoms and offer tailored interventions. Following our protocol and using the exact model shared in that paper, our primary aim in this study is to assess the prospective validity of mental health symptom prediction using the mindLAMP app through a replication study. We also explored secondary aims around app intervention personalization and correlations of engagement with the Technology Acceptance Model (TAM) and Digital Working Alliance Inventory scale in the context of automating the study. The study was 28 days in duration and followed the published protocol, with participants collecting digital phenotyping data and being offered optional scheduled and algorithm-recommended app interventions. Study compensation was tied to the completion of weekly surveys and was not otherwise tied to engagement or use of the app. The data from 67 participants were used in this analysis. The area under the curve values for the symptom prediction model ranged from 0.58 for the UCLA Loneliness Scale to 0.71 for the Patient Health Questionnaire-9. Engagement with the scheduled app interventions was high, with a study mean of 73%, but few participants engaged with the optional recommended interventions. The perceived utility of the app in the TAM was higher (P=.01) among those completing at least one recommended intervention. Our results suggest how digital phenotyping methods can be used to create generalizable models that may help create more personalized and engaging mental health apps. Automating studies is feasible, and our results suggest targets to increase engagement in future studies. RR2-10.2196/37954.