Confirmatory Factor Analysis of the Patient Version of the Working Alliance Inventory–Short Form Revised

Abstract

The working alliance concerns the quality of collaboration between patient and therapist in psychotherapy. One of the most widely used scales for measuring the working alliance is the Working Alliance Inventory (WAI). For the patient-rated version, the short form developed by Hatcher and Gillaspy (WAI-SR) has shown the best psychometric properties. In two confirmatory factor analyses of the WAI-SR, approximate fit indices were within commonly accepted norms, but the likelihood ratio chi-square test showed significant ill-fit. The present study used Bayesian structural equations modeling with zero mean and small variance priors to test the factor structure of the WAI-SR in three different samples (one American and two Swedish; N = 235, 634, and 234). Results indicated that maximum likelihood confirmatory factor analysis showed poor model fit because of the assumption of exactly zero residual correlations. When residual correlations were estimated using small variance priors, model fit was excellent. A two-factor model had the best psychometric properties. Strong measurement invariance was shown between the two Swedish samples and weak factorial invariance between the Swedish and American samples. The most important limitation concerns the limited knowledge on when the assumption of residual correlations being small enough to be considered trivial is violated.

The therapeutic alliance in different mental disorders: A comparison of patients with depression, somatoform, and eating disorders

“…The instrument captures Bordin's () concept of the therapeutic alliance with the three dimensions Bond , Task, and Goal . In several studies, a two factor model with a Bond factor and a Goal & Task factor showed the best psychometric fit (e.g., Falkenström, Hatcher, & Holmqvist, ; Mander et al ., ; Webb et al ., ). The items of the WAI‐SR were rated on a five‐step scale ranging from 1 (does not apply) to 5 (applies fully).…”

The bodymind model: A platform for studying the mechanisms of change induced by art therapy

“… * Includes aspects of both body and mind ** May be present and experienced on the self-engagement level, but need to be consciously expressed for it to be measured. 1 (Bradley & Lang, 1994) 2 (Allen, Chambers, & Towers, 2007) 3 (Miller, Maletic, & Raison, 2009) 4 (Lane, Quinlan, Schwartz, Walker, & Zeitlin, 1990) 5 (Benjamin, 1995) 6 ( Politi, Enright, & Weihs, 2007) 7 (Carlson & Brown, 2005) 8 (Bond et al, 2011) 9 (Fonagy et al, 2016) 10 (Jackson & Marsh, 1996) 11 (Falkenström, Hatcher, & Holmqvist, 2015) 12 (Hatcher & Gillaspy, 2006) 13 (Klein, Mathieu-Coughlan, & Kiesler, 1986) 14 (Babyak, Snyder, & Yoshinobu, 1993) 15 (Snyder, 1995) 16 (Tsai, Knutson, & Fung, 2006) 17 (Fegg, Kramer, Bausewein, & Borasio, 2007) 18 (Eriksson & Lindström, 2006) …”

“…Furthermore, we believe that negative emotions can be channeled to the art materials, art making process and product leaving more “room” for positive emotional regard between client and therapist (Schaverien, 1987). The working alliance can be measured with the Working Alliance Inventory, short form revised (WAI-SR) (Falkenström, Hatcher, & Holmqvist, 2015; Hatcher & Gillaspy, 2006). …”

Early psychotherapeutic empathy, alliance, and client outcome: Preliminary evidence of indirect effects

“…When evaluating the facets of the alliance, we found that early empathy experiences were significantly associated with goals and tasks (but not bond ). Large correlations have been reported between goals and tasks (e.g., Patterson, Uhlin, & Anderson, ), and some factor analyses have shown that goals and tasks items load on the same factor (e.g., Andrusyna, Tang, DeRubeis, & Luborsky, ; Falkenström, Hatcher, & Holmqvist, ), which has been labeled agreement (Webb et al., ). This potential link between empathy and agreement lends credence to the idea that empathy has pacing‐like effects (see Wong, ).…”