Working Alliance Ratings Research Articles

Patterns of working alliance development: A typology of client's working alliance ratings.

Patterns of working alliance development were detected by clustering working alliance ratings across 4 sessions of counseling. Results from an initial sample of recruited participants working with novice counselors (N = 38) revealed 3 patterns of alliance development labeled stable alliance, linear alliance growth, and quadratic alliance growth. Results from a replication sample (N = 41) of recruited participants also working with novice counselors, revealed 3 identical patterns of alliance development, which offered strong support for the validity of these growth patterns. As predicted by Gelso and Carter (1994), a pattern of quadratic alliance development was associated with greater improvement on measures of counseling benefit when compared to other patterns of alliance development. The discussion underscores the importance of examining both the strength (level) and pattern of development when examining the effects of the working alliance.

White Counselor Trainees' Racial Identity and Working Alliance Perceptions

Racial identity has been theorized to significantly affect cross‐racial counseling relationships (Helms, 1984, 1995). This study examined the direct impact of White racial identity of 124 counselor trainees on working alliance formation in a same‐racial and cross‐racial vicarious counseling analogue. Regardless of the race of the client, disintegration and reintegration attitudes negatively affected working alliance ratings, and pseudoindependent and autonomy attitudes positively affected working alliance ratings. Implications for counseling, supervision, training, and research are discussed.

Outcome assessment after milieu-oriented rehabilitation: New considerations

Objective: This study incorporated level of functional impairment ratings at program admission into rehabilitation outcome (return to work/school) at the time of program discharge. Hypotheses: (1) Patients and families with better working alliance ratings will show better adjusted outcome; (2) patients seeking compensation will have poorer outcome than those not seeking compensation or receiving benefits; (3) speed of information processing and memory will relate to the level of adjusted outcome. Design: Consecutive neurorehabilitation admissions from March 1992 to May 1996. Setting: Outpatient milieu-based interdisciplinary day treatment program. Subjects: Sixty-four patients with heterogeneous brain injury etiologies. Main Outcome Measures: Adjusted outcome, defined as level of discharge productivity adjusted by staff ratings of functional severity of impairment at program admission; work readiness and work eagerness, based on average staff ratings. Results: At discharge, 89.5% of patients showed fair or good adjusted outcome; 62% were gainfully employed/full-time students; 15.6% resumed preinjury status. Better working alliance predicted better adjusted outcome. Patients seeking compensation showed significantly lower work eagerness ratings. Poorer outcome was associated with better neuropsychological status. Conclusions: Efficacy of neurorehabilitation was demonstrated for patients with better working alliance who were not seeking compensation. Adjusted outcome demonstrated greater sensitivity and utility by incorporating the variable of functional severity of impairment at program admission. Inclusion of “process” variables addressing working alliance, motivation, and capacity to work provide important contributions to understanding rehabilitation outcome.

The Effect of Nonverbal Skills Training on Counselor Trainee Nonverbal Sensitivity and Responsiveness and on Session Impact and Working Alliance Ratings

Counselor trainees (N = 18) were randomly assigned to treatment (nonverbal sensitivity) or control (empathy training) conditions. Trainees saw a recruited client before (first 2 weeks) and after (last 2 weeks) a 15‐week counseling methods class. Trainees rated their sensitivity to nonverbal behaviors, counseling self‐efficacy, and the extent to which they focused on client nonverbal behavior. Clients filled out the Session Evaluation Questionnaire and Working Alliance Inventory at pre‐ and posttesting. Trained raters viewed videotapes of the counseling sessions and rated the extent that counselors focused on client nonverbal behavior. As hypothesized, trainees in the treatment condition, when compared with those in the control condition, increased their focus on client nonverbal behaviors. In addition, clients of treatment condition counselors showed significant differences in working alliance ratings. Trainees in both conditions increased their rating of nonverbal sensitivity and self‐efficacy from pre‐ to posttesting. Implications are discussed.

Client attachment and perceptions of the working alliance with counselor trainees.

The relationships among 3 dimensions of client attachment (depend, anxiety, and close) and client ratings of the working alliance were examined in a sample of first-time clients (N = 60) seeking services through a university-based counseling clinic. Working alliance ratings were collected from all participants immediately after their 3rd counseling session with a counselor-in-training. A significant association was found between the depend dimension of attachment and client working alliance ratings

Working alliance, attachment memories, and social competencies of women in brief therapy.

Current social competencies and memories of attachment bonds with each parent were examined as they related to influences on formation of the working alliance. Female clients (N = 76) at 4 university and community agencies completed surveys containing the Parental Bonding Instrument, the Self-Efficacy Scale, the Adult Attachment Scale, and the Working Alliance Inventory. Results indicated that parental bonds, especially with fathers, were significantly associated with social competencies. Multiple regression analyses indicated that social competencies (self-efficacy and adult attachment) accounted for 14% of the variance in client working alliance ratings, whereas recalled parental bonds accounted for 23% of the variance. Working alliance was negatively associated with father bonds, positively associated with mother bonds, and-among social competencies-significantly associated with capacity for adult attachment

Alliance and Technique for Predicting Outcome in Short-and Long-Term Analytic Psychotherapy

A previous clinical trial provided the opportunity to examine the roles and interaction of alliance and technique in both short- and long-term analytic psychotherapy. Two separate teams of trained clinical judges rates either alliance on the CALPAS or therapist interventions on the ITS. Outcome included symptomatology and interpersonal problems. In short-term therapy, working and therapeutic alliance ratings contributed significantly to the reduction of symptomatology only. In long-term therapy, working alliance ratings contributed significantly to the reduction of interpersonal problems, and the interaction of working alliance ratings with supportive or exploratory intervention rating were found to account for significant amounts of the variance of both symptomatology and interpersonal problems at termination. These findings should be considered with caution, given the restricted sample sizes.

Clients' representations of childhood emotional bonds with parents, social support, and formation of the working alliance.

Survey data were collected from 102 client-counselor dyads at 3 counseling centers with regard to (a) client and counselor 3rd-session working alliance ratings, (b) quality of clients' current social relationships, as evidenced by social-support satisfaction, and (c) clients' representations of care and overprotection in their memories of childhood emotional bonds with their mothers and fathers. Care pertains to memories of parents' emotional responsiveness, warmth, and attention to clients' needs. Overprotection pertains to memories of parents' intrusive control and resistance at attempts to gain independence. Results indicated that social support was a significant predictor of client-rated working alliance, whereas clients' bonds with fathers were a significant predictor of counselor-rated working alliance. A trend toward interactions between social support and parental bonds in predicting counselor-rated alliance was also suggested. The working alliance, with conceptual origins in psychodynamic theory (cf. Sterba, 1934; Zeitzel, 1956), has been proposed as a part of the counseling relationship that is crucial to successful outcome regardless of the theoretical underpinnings of the therapy (Bordin, 1979, 1980). Drawing from the work of Greenson (1967) and Bordin (1979), Gelso and Carter (1985) described the working alliance as an emotional alignment between the counselor and the client that engages the self-observing, rational aspects of the client and the working, therapizing aspects of the counselor. Bordin (1979) suggested that the working alliance is composed of emotional bonds of trust and attachment between counselor and client, as well as agreement about the goals of treatment and the therapeutic tasks needed to achieve those goals. Evidence documenting the importance for successful therapy outcome of the counseling relationship in general (Orlinsky & Howard, 1986), and the working alliance in particular (for reviews see Gaston, 1990; Horvath & Symonds, 1991), continues to accumulate. Some studies have reported quite strong associations, with the working alliance accounting for up to 30%-45% of the variance in therapeutic outcome (Horvath & Greenberg, 1989). A recent meta-analysis reported a more modest, but nevertheless significant, effect size averaged across 24 studies (Horvath & Symonds, 1991). Although the bulk of previous research has examined the working alliance as a predictor of therapy outcome, more attention has been given recently to predictors of the working alliance itself, with studies of factors that affect counselors' capacity to form working alliances (Mallinckrodt & Nelson, 1991), as