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Psychiatric Quarterly

, Volume 88, Issue 3, pp 623–633 | Cite as

Patient-Therapist Perspective of the Working Alliance in Psychotherapy

  • Nelson Andrade-GonzálezEmail author
  • Guillermo Lahera
  • Alberto Fernández-Liria
Original Paper

Abstract

This study aimed to examine perceptions of the working alliance in a sample of Spanish patients and therapists. The alliance was measured after the third and tenth psychotherapy sessions using patient and therapist versions of the Spanish adaptation of the Working Alliance Inventory (WAI). After both sessions, correlations between the patients’ and therapists’ ratings, both of total alliance and of the various dimensions of the alliance, were moderate at best. Moreover, after the third psychotherapy session, patients’ scores for the total alliance and the Goal and Task subscales were significantly higher than the scores from their therapists in these dimensions. Following the tenth session, patient ratings exceeded those of their therapists only on the Task subscale. Finally, in contrast to the ratings of patients, therapists’ alliance ratings increased significantly between the third and tenth sessions of psychotherapy. Certain recommendations are presented to improve the study of patient and therapist perceptions of the working alliance and to increase the convergence between them with regard to this central treatment variable.

Keywords

Working alliance Patient perspective Therapist perspective Patient-therapist convergence 

Notes

Compliance with Ethical Standards

Conflict of Interest

All authors declared no conflicts of interest.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Tryon GS, Blackwell SC, Hammel EF: A meta-analytic examination of client-therapist perspectives of the working alliance. Psychother Res 17: 629–642, 2007.CrossRefGoogle Scholar
  2. 2.
    Stiles WB, Goldsmith JZ: The alliance over time. In: Muran JC, Barber JP, editors. The therapeutic alliance: an evidence-based guide to practice. New York NY, Guilford Press, 2010. pp. 44–62.Google Scholar
  3. 3.
    Fitzpatrick MR, Iwakabe S, Stalikas A: Perspective divergence in the working alliance. Psychother Res 15:69–79, 2005.CrossRefGoogle Scholar
  4. 4.
    Horvath AO: An exploratory study of the working alliance: its measurement and relationship to therapy outcome (unpublished doctoral dissertation). Vancouver Canada, University of British Columbia, 1981.Google Scholar
  5. 5.
    Horvath AO, Greenberg LS: The development of the Working Alliance Inventory. In: Greenberg LS, Pinsof WM, editors. The psychotherapeutic process: a research handbook. New York NY, Guilford Press, 1986. pp. 529–556.Google Scholar
  6. 6.
    Horvath AO, Greenberg LS: Development and validation of the Working Alliance Inventory. J Couns Psychol 36:223–233, 1989.CrossRefGoogle Scholar
  7. 7.
    Hilsenroth MJ, Peters EJ, Ackerman SJ: The development of therapeutic alliance during psychological assessment: patient and therapist perspectives across treatment. J Pers Assess 83:332–344, 2004.CrossRefPubMedGoogle Scholar
  8. 8.
    Hatcher RL, Barends AW: Patient’s view of the alliance in psychotherapy: exploratory factor analysis of three alliance measures. J Consult Clin Psychol 64:1326–1336, 1996.CrossRefPubMedGoogle Scholar
  9. 9.
    Hatcher RL: Therapists’ views of treatment alliance and collaboration in therapy. Psychother Res 9:405–423, 1999.CrossRefGoogle Scholar
  10. 10.
    Andrade-González N, Fernández-Liria A: Spanish Adaptation of the Working Alliance Inventory (WAI): psychometric properties of the patient and therapist forms (WAI-P and WAI-T). Anales de Psicología 31:524–533, 2015.Google Scholar
  11. 11.
    American Psychiatric Association: Manual diagnóstico y estadístico de los trastornos mentales [Diagnostic and statistical manual of mental disorders] 4.ª ed. text rev. Barcelona Spain, Masson, 2002.Google Scholar
  12. 12.
    Bordin ES: The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy (Chic) 16:252–260, 1979.CrossRefGoogle Scholar
  13. 13.
    Bordin ES: Theory and research on the therapeutic working alliance: new directions. In: Horvath AO, Greenberg LS, editors. The working alliance: theory, research and practice. New York NY, John Wiley & Sons, 1994. pp. 13–37.Google Scholar
  14. 14.
    Falkenström F, Hatcher RL, Holmqvist R: Confirmatory factor analysis of the patient version of the Working Alliance Inventory-Short form revised. Assessment 22:581–593, 2015.CrossRefPubMedGoogle Scholar
  15. 15.
    Doran JM: The working alliance: where have we been, where are we going? Psychother Res 26:146–163, 2016.CrossRefPubMedGoogle Scholar
  16. 16.
    Horvath AO: The therapeutic relationship: from transference to alliance. J Clin Psychol 56:163–173, 2000.CrossRefPubMedGoogle Scholar
  17. 17.
    Horvath AO, Greenberg LS: Introduction. In: Horvath AO, Greenberg LS, editors. The working alliance: theory, research and practice. New York NY, John Wiley & Sons, 1994. pp. 1–9.Google Scholar
  18. 18.
    Sexton HC, Hembre K, Kvarme G: The interaction of the alliance and therapy microprocess: a sequential analysis. J Consult Clin Psychol 64:471–480, 1996.CrossRefPubMedGoogle Scholar
  19. 19.
    Tracey TJ, Kokotovic AM: Factor structure of the Working Alliance Inventory. Psychol Assess 1:207–210, 1989.CrossRefGoogle Scholar
  20. 20.
    Paivio SC, Patterson LA: Alliance development in therapy for resolving child abuse issues. Psychotherapy 36:343–354, 1999.CrossRefGoogle Scholar
  21. 21.
    Kivlighan DM, Shaughnessy P: Analysis of the development of the working alliance using hierarchical linear modeling. J Couns Psychol 42:338–349, 1995.CrossRefGoogle Scholar
  22. 22.
    Tryon GS, Blackwell SC, Hammel EF: The magnitude of client and therapist working alliance ratings. Psychotherapy (Chic) 45:546–551, 2008.CrossRefGoogle Scholar
  23. 23.
    Bachelor A: Clients’ and therapists’ views of the therapeutic alliance: similarities, differences and relationship to therapy outcome. Clin Psychol Psychother 20:118–135, 2013.CrossRefPubMedGoogle Scholar
  24. 24.
    Safran JD, Muran JC: Negotiating the therapeutic alliance: a relational treatment guide. New York NY, Guilford Press, 2000.Google Scholar
  25. 25.
    Lambert MJ, Shimokawa K: Collecting client feedback. In: Norcross JC, editor. Psychotherapy relationships that work: evidence-based responsiveness. New York NY, Oxford University Press, 2011. pp. 203–223.CrossRefGoogle Scholar
  26. 26.
    Norcross JC, Wampold BE: Evidence-based therapy relationships: research conclusions and clinical practices. In: Norcross JC, editor. Psychotherapy relationships that work: evidence-based responsiveness. New York NY, Oxford University Press, 2011. pp. 423–430.CrossRefGoogle Scholar
  27. 27.
    Sharpless BA, Muran JC, Barber JP: Coda: recommendations for practice and training. In: Muran JC, Barber JP, editors. The therapeutic alliance: an evidence-based guide to practice. New York NY, Guilford Press, 2010. pp. 341–354.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nelson Andrade-González
    • 1
    Email author
  • Guillermo Lahera
    • 2
    • 3
  • Alberto Fernández-Liria
    • 2
  1. 1.Relational Processes and Psychotherapy Research Group, Faculty of Medicine and Health SciencesUniversity of Alcalá, Campus UniversitarioAlcalá de HenaresSpain
  2. 2.Faculty of Medicine and Health SciencesUniversity of AlcaláAlcalá de HenaresSpain
  3. 3.IRyCIS, CIBERSAMMadridSpain

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