Observing the Working Alliance in Videoconferencing Psychotherapy for Alcohol Addiction: Reliability and Validity of the Working Alliance Inventory Short Revised Observer

Abstract

The coronavirus disease-2019 (COVID-19) pandemic has affected the mental health and alcohol consumption of individuals. Videoconferencing psychotherapy has become a fundamental mode of treatment for people with alcohol use disorders. However, there are still doubts about its effectiveness and the therapeutic relationship. The working alliance is considered a foundation of effective practice in cognitive behavioral therapy (CBT). Observer measurements of the working alliance have demonstrated reliability and meaningful associations with the reduction of symptoms. However, translations of instruments to evaluate the working alliance and examine its construct have not previously been conducted for online psychotherapy for alcohol addiction. This study aimed for the cross-cultural adaptation of the Working Alliance Inventory-Short Form-Observer (WAI-SR-O) for Brazil and the evaluation of its reliability and evidence of its validity in videoconferencing psychotherapy for alcoholism. The WAI-SR-O was applied by pairs of observers for the evaluation of the working alliance in 19 recorded sessions of videoconferencing psychotherapy of 10 clients with a diagnosis of alcohol addiction. The sessions were also evaluated by the therapist (WAI-T) and client (WAI-C). The WAI-SR-O shows a moderate inter-rater intraclass correlation coefficient (ICC = 0.67) for the general scale, higher ICC for the goals and bond subscales, and a moderate value for the task subscale. The internal consistency was good (a = 0.86). The results show low but significant correlations among the goals and bond subscales of the WAI-SR-O and the general, goals, and bond scales of the WAI-T. No correlations were found with the WAI-C. As the literature points out, the client, therapist, and observer versions of the WAI evaluated the alliance differently, requiring further study. The WAI-SR-O proved to be a reliable and valid measurement for the evaluation of the working alliance in videoconferencing psychotherapy for alcohol addiction, becoming an important tool for the study of the working alliance in telepsychotherapy.

Aliança terapêutica e adesão à Terapia CognitivoComportamental na modalidade online para dependentes de álcool

“…There is even a tendency to consider an external observer's assessment to be the most sensitive. Similar results were found in the study to evaluate the psychometric properties of the WAI observer version for the Brazilian population (Ribeiro et al, 2021).…”

“…In addition, the Brazilian versions of the WAI-C and WAI-T for internet use are still in the process of analyzing evidence of analysis. Initial results can be seen in Ribeiro et al (2021) and Ribeiro (2017). Another limitation is that the analyses are based only on videoconference interventions, and they are not compared with other telepsychotherapy modalities of face-to-face psychotherapy.…”

Observer and client perceptions of therapist multicultural orientation in a jail setting.

“…Results indicated no relationship between client and observer ratings of cultural humility, missed cultural opportunities, or therapeutic alliance. Although in alignment with prior research (e.g., Bachelor, 2013; Constantine, 2002; Fuertes et al, 2006; Polaschek & Ross, 2010; Ribeiro et al, 2021; Soto et al, 2018; Worthington et al, 2000), these relationships, or lack thereof, must be considered tentatively and with caution. As noted earlier, to evaluate therapists’ cultural humility, missed cultural opportunities and therapeutic alliance observers and clients rated constructs at different time points throughout the treatment episode sessions (i.e., the intake and third session, respectively).…”

“…Perspectives of the therapeutic processes can differ based on informant (i.e., clients, therapists, independent observers; Bachelor, 2013; Caron et al, 2020; Horvath, 2018; Luong et al, 2022; Polaschek & Ross, 2010; Ribeiro et al, 2021). For instance, Polaschek and Ross (2010) found significant differences between client-, therapist- and observer perspectives of working alliance, with clients reporting the therapeutic alliance as the strongest, followed by therapists, and then observers.…”

“…It was also anticipated that clients who perceived their therapist as less responsive to opportunities for cultural discussion during sessions (i.e., the therapist missed more cultural opportunities) would report a weaker therapeutic alliance. Additionally, given that previous research suggests client ratings of therapeutic alliance or cultural processes during session have been unrelated to therapist- (Fuertes et al, 2006; Gergov et al, 2021; Polaschek and Ross, 2010; Soto et al, 2018) or observer ratings (e.g., Constantine, 2001; Flückiger et al, 2018; Luong et al, 2022; Polaschek & Ross, 2010; Ribeiro et al, 2021; Worthington et al, 2000), it was speculated that client and observer ratings of therapist cultural humility, missed cultural opportunities, and therapeutic alliance would be unrelated.…”