Structural characteristics and external correlates of the Working Alliance Inventory-Short Form.

Abstract

Controversy remains on the psychometric properties of the Working Alliance Inventory-Short Form (WAI-S). In the present study we first examined the factor structure and reliability of WAI-S scores in a sample of 557 Flemish mental health consumers. Subsequently, we investigated the relationship between early alliance quality and client's psychological dysfunctioning (symptomatic distress, interpersonal functioning and personality pathology). Participants completed the Outcome Questionnaire and the Dimensional Assessment of Personality Pathology-Short Form at start of treatment. The WAI-S was completed after the third treatment session. The structure of the WAI-S was examined using confirmatory factor analysis. Four different factor models were compared. Internal consistencies of the scales were ascertained using the Cronbach's alpha coefficient. Pearson correlations were calculated to determine the relationships between alliance ratings and the independent variables. CFA resulted in a two-factor model, with a Bond component (Contact) and a Task-Goal (Contract) component. Reliability of the WAI-S subscale scores proved to be very good. Symptomatic distress, interpersonal dysfunctioning and personality traits were associated to the Contract component of the alliance, but not to the Contact component. Clinical implications, limitations and suggestions for further research are formulated.

The relationship between clients’ personality traits, working alliance and therapy outcome in a training context

“…Based on previous studies, one could expect that personality traits would affect therapeutic outcome (Coleman, 2006;Hirsh et al, 2012;Krasner et al, 2009;Smits et al, 2015;Spek et al, 2008). Surprisingly, pre-therapy personality traits did not predict post-therapy symptoms in the present study; only pre-therapy symptoms did.…”

“…In addition, most previous studies employed cross-sectional experimental designs (Coleman, 2006;Kotov et al, 2010;Smits et al, 2015), whereas the present investigation was longitudinal. Another strength of the present study is the use of two different outcome measures: working alliance and post-therapy symptoms, tapping two different but likely related domains of interest.…”

“…For example, Hirsh et al (2012) reported a positive relationship between Agreeableness and alliance in a sample of 87 borderline patients. Smits et al (2015) examined a sample of 557 psychiatric patients, and their results showed negative correlations between Emotional Dysregulation (a reciprocal of Neuroticism), Dissocial Behavior (an inverse of Agreeableness), and the contract (Task and Goal) components of the alliance.…”

“…Similar results have been found in other studies. More alexithymia (low scores on Openness) and less hedonic capacity (low scores on Extraversion) have been related to lower social competence, insecure relations and worse working alliance (Coleman, 2006;Mohaupt, Holgersen, Binder, & Höstmark Nielsen, 2006), and more negative affect or neuroticism has been shown to correlate negatively with the working alliance (Smits et al, 2015).…”

“…One of the models that has been found useful in the study of client personality in relation to therapeutic process and outcome research is the five-factor model (FFM) of personality (e.g., Coleman, 2006;Hedman et al, 2014;Hirsh, Quilty, Bagby, & McMain, 2012;John & Srivastava, 1999;Krasner et al, 2009;Lee & Bowen, 2015;Smits, Luyckx, Smits, Stinckens, & Claes, 2015;Tang et al, 2009). The FFM represents the broadest, most consistent dimensions that have been used in investigations of personality traits (John & Srivastava, 1999).…”