Development and validation of the Working Alliance Inventory.

Horvath, Adam O.; Greenberg, Leslie S.

doi:10.1037/0022-0167.36.2.223

Cited by 3,098 publications

(3,014 citation statements)

References 43 publications

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“…We were interested in the question of whether patients could also build a therapeutic relationship with more than one therapist. To answer this question, following the final treatment session, all patients filled in the Working Alliance Inventory (WAI), short version (Horvath & Greenberg, 1989; Tracey & Kokotovic, 1989), a commonly used and reliable scale to measure the quality of the therapeutic relationship operationalized as the working alliance. Because more than one therapist was involved in the treatment, for each of the 12 items we replaced the word ‘therapist’ with ‘therapist team’.…”

Section: Examplementioning

confidence: 99%

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Minnen

Hendriks

Kleine

et al. 2018

European Journal of Psychotraumatology

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Background: Trauma-focused treatments (TFTs) for patients with post-traumatic stress disorder (PTSD) are highly effective, yet underused by therapists.Objective: To describe a new way of implementing (adequate use of) TFTs, using a therapist rotation model in which one patient is treated by several therapists.Method: In this article, we will present two examples of working with therapist rotation teams in two treatment settings for TFT of PTSD patients. We explore the experiences with this model from both a therapist and a patient perspective.Results: Our findings were promising in that they suggested that this novel approach reduced the therapists’ fear of providing TFT to PTSD patients, increased perceived readiness for TFT, and decreased avoidance behaviour within TFT sessions, possibly leading to better implementation of TFT. In addition, the therapeutic relationship as rated by patients was good, even by patients with insecure attachment styles.Conclusions: We suggest that therapist rotation is a promising novel approach to improve implementation of TFT for PTSD.

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Section: Examplementioning

confidence: 99%

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Minnen

Hendriks

Kleine

et al. 2018

European Journal of Psychotraumatology

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“…Working Alliance Inventory (WAI; Horvath and Greenberg, 1989): The WAI is a 36-item selfreport questionnaire comprising 3 subscales of 12 items each, with respondents rating their level of agreement to statements using a 7-point Likert-like scale. The subscales assess the goals of therapy, the tasks of therapy, and the bond that develops between the clinician and patient.…”

Section: Assessmentsmentioning

confidence: 99%

“…The range of the total scores is from 36 to 252 with higher scores indicating greater therapeutic alliance. The WAI is the most widely used assessment for measuring the therapeutic alliance (Fenton et al, 2001), has well established reliability and validity (Hanson et al, 2002;Horvath and Greenberg, 1989), and has parallel forms for clinicians and patients. In the current study the WAI was administered after the third week post-randomization visit in each condition.…”

Section: Assessmentsmentioning

confidence: 99%

The therapeutic alliance in medical-based interventions impacts outcome in treating alcohol dependence

Dundon

Pettinati

Lynch

et al. 2008

Drug and Alcohol Dependence

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This study examined the relationship of the therapeutic alliance and treatment outcomes for alcohol dependent patients receiving naltrexone or placebo and one of three different types of clinical interventions, including two medical-based (non-specialty) treatments. This is a secondary analysis of a 24-week randomized, placebo-controlled, clinical trial of 100 mg/day of naltrexone or placebo for patients with DSM-IV alcohol dependence. Patients were also randomized to one of three interventions: 1) medication clinic only, 2) medication clinic plus BRENDA (an intervention promoting pharmacotherapy), or 3) medication clinic plus Cognitive Behavioral Therapy (CBT). Early in treatment, patients and clinicians completed the Working Alliance Inventory (WAI). Regression analyses were conducted to determine the predictive validity of the WAI on percent days abstinent and percent of sessions attended over the clinical trial. In the medication clinic only condition, the clinicians' WAI total score was marginally correlated to percent of visits attended (p = .057) but not percent days abstinent. In the medication clinic plus BRENDA condition, clinicians' WAI total score was positively correlated with percent days abstinent (p = .013) but not percent visits attended. No significant relationships were found between the WAI scores and either outcome measure in the CBT condition or for any of the patient rated assessments. To our knowledge, this is the first published report providing some support for the importance of the therapeutic alliance in medical interventions for alcohol dependence but only in the context of the clinicians' ratings. The absence of other effects underscores the need for further research.

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“…Each item is rated on a 7-point scale (1=never, 7=always). Research has shown strong support for the reliability of the WAI, ranging from α=.85 to .93 (Horvath & Greenberg, 1989). This study used a modified version of the WAI to capture the participants' perspective on the alliance in a one-time group workshop.…”

Section: Attributions-thementioning

confidence: 99%

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

Eisner

Johnson

2008

Behavior Therapy

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Expressed emotion (EE) is a robust predictor of outcome in bipolar disorder. Despite decades of research, interventions to reduce EE levels have had only modest effects. This study used an expanded model of EE to develop an intervention. Research has demonstrated a strong link between attributions and EE in families of patients with psychiatric disorders. There is also substantial research to suggest that anger can drive blaming attributions. Combining these ideas, this study built on previous psychoeducation interventions through the addition of an acceptance component designed to decrease anger and blaming attributions among family members of those with bipolar disorder. Twenty-eight family members attended a 1-day or 2-evening multifamily group workshop and completed a followup assessment 1 week later. At follow-up, participants demonstrated more knowledge about bipolar disorder. Anger, blaming attributions, and number of criticisms remained unchanged. Results of this study are consistent with others in that it is difficult to change EE. Implications for future clinical research in this area are addressed.The construct of expressed emotion (EE) is defined as critical, hostile, or emotionally overinvolved (EOI) attitudes toward a relative with a psychiatric disorder (Hooley, Rosen, & Richters, 1995). EE has been linked with poor patient outcome for several psychiatric disorders (Barrowclough & Hooley, 2003;Butzlaff & Hooley, 1998). Butzlaff and Hooley (1998) found a meta-analytic effect size of r=.39 across six studies that examined the relationship between EE and relapse within mood disorders. More recent research suggests that, although EE was unrelated to manic relapse, high EE was related to a five-fold increase in the odds of a depressive recurrence, even after controlling for symptom severity (Yan, Hammen, Cohen, Daley, & Henry, 2004). Criticism has been found to be the most important element of EE for understanding the course of mood disorders (Hooley et al., 1995) and for bipolar depression (Kim & Miklowitz, 2004). Thus, EE has an influence on bipolar relapse, more specifically for depression.What drives high levels of criticism? According to Weiner's (1995) attribution-affect model, attributions influence the way people experience emotion. In particular, when an individual perceives that another person is in control of his or her behavior, this leads to a judgment that the other person is responsible for his or her behavior. A judgment that the other person is responsible elicits anger and criticism. High EE relatives who are critical have a tendency to view symptoms of mental illness as behaviors that are within the patient's control (Barrowclough, Johnston, & Tarrier, 1994). Because high EE relatives believe the patient is in control of his or her behavior, they believe the patient must also be capable of modifying this behavior. Thus, relatives struggle to normalize the patient's behavior through negative feedback and controlling behavior of their own (Hooley & Campbell, 2002 Several studie...

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Development and validation of the Working Alliance Inventory.

Cited by 3,098 publications

References 43 publications

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

The therapeutic alliance in medical-based interventions impacts outcome in treating alcohol dependence

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

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