Mutual agreement between the patient and the psychotherapist in psychotherapy. Psychometrics value and factor structure of the Working Alliance Inventory

Tomasz Prusiński

Pracownia Testów Psychologicznych, Instytut Psychologii, Akademia Pedagogiki Specjalnej w Warszawie
https://orcid.org/0000-0002-8782-1498


Abstract

The aim of the present research was to investigate the structure of working alliance assessed by means of the Working Alliance Inventory (WAI, two versions: WAI-PA for patients and WAI-PT for psychotherapists) and to present the Polish version of the 36-item WAI and its psychometric properties.

The adopted validation strategy brought the expected results, revealing the three-factor structure of the Polish versions of the WAI identical to the structure of the original measures. The results of the analyses provided strong evidence pointing to the acceptable goodness of working alliance quality measurement using the Polish versions of the examined instruments. WAI is a psychometrically valuable measure.


Keywords:

przymierze w działaniu, rzetelność i trafność WAI


Andrade-González, N., Fernández-Liria, A. (2015). Spanish Adaptation of the Working Alliance Inventory (WAI). Psychometric properties of the patient and therapist forms (WAI-P and WAI-T). Annals of Psychology, 31(2), 524‒533. DOI: 10.6018/analesps.31.2.177961.
Crossref   Google Scholar

Andrusyna, T. P., Tang, T. Z., DeRubeis, R. J., Luborsky, L. (2001). The factor structure of the Working Alliance Inventory in cognitive-behavioral therapy. The Journal of Psychotherapy Practice and Research, 10(3), 173‒178.   Google Scholar

Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., Lutz, W., Rubel, J., Schiefele, A. K., Peri, T. (2015). Therapeutic bond judgments: Congruence and incongruence. Journal of Consulting and Clinical Psychology, 83(4), 773–784.
Crossref   Google Scholar

Bat Or, M., Zilcha-Mano, S. (2019). The art therapy working alliance inventory: The development of a measure. International Journal of Art Therapy, 24(2), 76‒87. DOI: 0.1080/17454832.2018.1518989.
Crossref   Google Scholar

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260.
Crossref   Google Scholar

Bordin, E. S. (1994). Theory and research on the therapeutic working alliance: New directions. W: A. O. Horvath, L. S. Greenberg (red.), The working alliance: Theory, research, and practice (s. 13–37). New York: Wiley.   Google Scholar

Busseri, M. A., Tyler, J. D. (2003). Interchangeability of the working alliance inventory and working alliance inventory, short form. Psychological Assessment, 15(2), 193‒197.
Crossref   Google Scholar

Cierpiałkowska, L. (2018). Sojusz terapeutyczny a efektywność terapii osób z zaburzeniami zachowania związanymi z hazardem. Uzależnienia, 3(83), 6‒11.   Google Scholar

Cierpiałkowska, L., Kubiak, J. (2010). Niespecyficzne czynniki leczące a efektywność terapii alkoholików. Nauka, 2, 89‒111.   Google Scholar

Cirasola, A., Midgley, N., Fonagy, P., Impact Consortium, Martin, P. (2020). The factor structure of the Working Alliance Inventory Short Form in youth psychotherapy: An empirical investigation. Psychotherapy Research, 31(4), 535‒547. DOI:10.1080/10503307.2020.1765041.
Crossref   Google Scholar

Crits-Christoph, P., Gallop, R., Gaines, A., Rieger, A., Connolly Gibbons, M. B. (2020). Instrumental variable analyses for causal inference: Application to multilevel analyses of the alliance-outcome relation. PsychotherapyResearch,30, 53–67. DOI: 10.1080/10503307.2018.1544724.
Crossref   Google Scholar

Cronbach, L. J., Meehl, P. E. (2005). Trafność teoretyczna testów psychologicznych. W: J. Brzeziński (red.), Trafność i rzetelność testów psychologicznych. Wybór tekstów (s. 177‒212). Gdańsk: GWP.   Google Scholar

Czabała, Cz. (2013). Czynniki leczące w psychoterapii. Warszawa: PWN   Google Scholar

Del Re, A. C., Flückiger, C., Horvath, A. O., Wampold, B. E. (2021). Examining therapist effects in the alliance-outcome relationship: A multilevel meta-analysis. Journal of Consulting and Clinical Psychology, 89(5), 371–378. DOI:10.1037/ccp0000637.
Crossref   Google Scholar

Gaston, L. (1990). The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations. Psychotherapy: Theory, Research, Practice, Training, 27(2), 143–153. DOI:10.1037/0033-3204.27.2.143.
Crossref   Google Scholar

Gelso, C. (2014). A tripartite model of the therapeutic relationship: Theory, research, and practice. Psychotherapy Research, 24(2), 117‒131. DOI: 10.1080/10503307.2013.845920.
Crossref   Google Scholar

Gómez Penedo, J. M., Berger, T., Grosse Holtforth, M., Krieger, T., Schröder, J., Hohagen, F., Klein, J. P. (2020). The Working Alliance Inventory for guided Internet interventions (WAI‐I). Journal of Clinical Psychology, 76(6), 973‒986. DOI: 10.1002/jclp.22823.
Crossref   Google Scholar

Guédeney, N., Fermanian, J., Curt, F., Bifulco, A. (2005). Testing the Working Alliance Inventory (WAI) in a French primary care setting. Social Psychiatry and Psychiatric Epidemiology, 40(10), 844‒852. DOI: 10.1007/s00127-005-0972-4.
Crossref   Google Scholar

Gülüm, İ. V., Sait, U. L. U. Ç., Soygüt, G. (2018). Psychometric properties of the Turkish working alliance inventory-short form. Turk PsikiyatriDergisi, 29(1), 1‒6. DOI: 10.5080/u18260.
Crossref   Google Scholar

Halfon, S., Özsoy, D., Çavdar, A. (2019). Therapeutic alliance trajectories and associations with outcome in psychodynamic child psychotherapy. Journal of Consulting and Clinical Psychology, 87(7), 603. DOI:10.1037/ccp0000415.
Crossref   Google Scholar

Hall, A. M., Ferreira, P. H., Maher, C. G., Latimer, J., Ferreira, M. L. (2010). The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Physical Therapy, 90(8), 1099‒1110.
Crossref   Google Scholar

Hartmann, A., Joos, A., Orlinsky, D. E., Zeeck, A. (2015). Accuracy of therapist perceptions of patients’ alliance: Exploring the divergence. Psychotherapy Research, 25(4), 408‒419. DOI: 10.1080/10503307.2014.927601.
Crossref   Google Scholar

Hatcher, R. L., Barends, A., Hansell, J., Gutfreund, M. J. (1995). Patients’ and therapists’ shared and unique views of the therapeutic alliance: An investigation using confirmatory factor analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636–643.
Crossref   Google Scholar

Hatcher, R. L., Gillaspy, J. A. (2006). Development and validation of a revised version of the working alliance inventory. Psychotherapy Research, 16(1), 12‒25.
Crossref   Google Scholar

Holopainen, R., Simpson, P., Piirainen, A., Karppinen, J., Schütze, R., Smith, A., O’Sullivan, P., Kenti, P.(2020). Physiotherapists’ perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions: Pain, 161, 1150–1168. DOI:10.1097/j.pain.0000000000001809.
Crossref   Google Scholar

Horvath, A. O. (1981). An exploratory study of the concept of therapeutic alliance and its measurement. Unpublished doctoral dissertation, University of British Columbia, Vancouver, Canada.   Google Scholar

Horvath, A. O. (1994). Empirical validation of Bordin’s pantheoretical model of alliance: the Working Alliance Inventory perspective. W: A. O. Horvath, L. S. Greenberg (red.), The working alliance. Theory, research, and practice (s. 109‒128). New Jersey: Wiley & Sons.   Google Scholar

Horvath, A.O. (2018). Research on the alliance: Knowledge in search of a theory. Psychotherapy Research, 28(4), 499–516.DOI: 10.1080/10503307.2017.1373204.
Crossref   Google Scholar

Horvath, A. O., Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 2(36), 223‒233.
Crossref   Google Scholar

Hsu, S., Yu, C. K. C. (2017). A Hong Kong study of working alliance inventory short form–therapist. Asia Pacific Journal of Counseling and Psychotherapy, 8(2), 87‒100. DOI: 10.1080/21507686.2017.1313285.
Crossref   Google Scholar

Hsu, S., Zhou, R. H., Yu, C. K. C. (2016). A Hong Kong validation of working alliance inventory – short form – client. Asia Pacific Journal of Counselling and Psychotherapy, 7(1–2), 69–81. DOI:10.1080/21507686.2016.1193036.
Crossref   Google Scholar

Hukkelberg, S. S., Ogden, T. (2016). The short Working Alliance Inventory in parent training: Factor structure and longitudinal invariance. Psychotherapy Research, 26(6), 719‒726. DOI: 10.1080/10503307.2015.1119328.
Crossref   Google Scholar

Hunik, L., Galvin, S., Hartman, T., Rieger, E., Lucassen, P., Douglas, K., Sturgiss, E. (2021). Exploring the psychometric properties of the Working Alliance Inventory in general practice: a cross-sectional study. BJGP Open, 5(1), 1‒9. DOI: 10.3399/bjgpopen20X101131.
Crossref   Google Scholar

Killian, M., Forrester, D., Westlake, D., Antonopoulou, P. (2017). Validity of the working alliance inventory within child protection services. Research on Social Work Practice, 27(6), 704‒715. DOI: 10.1177/1049731515596816.
Crossref   Google Scholar

Klajs, K. (2017). Poznawanie pacjenta. Poznań: Zysk i S-ka.   Google Scholar

Knowles, C., Murray, C., Gau, J., Toste, J. R. (2020). Teacher–Student Working Alliance Among Students with Emotional and Behavioral Disorders. Journal of Psychoeducational Assessment, 38(6), 753–761. DOI: 10.1177/0734282919874268.
Crossref   Google Scholar

LaCrosse, M. B. (1980). Perceived counselor social influence and counseling outcomes: Validity of the Counselor Rating Form. Journal of Counseling Psychology, 27, 320‒327.
Crossref   Google Scholar

Larsson, M. H., Falkenström, F., Andersson, G., Holmqvist, R. (2018). Alliance ruptures and repairs in psychotherapy in primary care. Psychotherapy Research, 28(1), 123‒136. DOI: 10.1080/10503307.2016.1174345.
Crossref   Google Scholar

Laws, H. B., Constantino, M. J., Sayer, A. G., Klein, D. N., Kocsis, J. H., Manber, R., Arnow, B. A. (2017). Convergence in patient–therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment. Psychotherapy Research, 27(4), 410‒424. DOI: 10.1080/10503307.2015.1114687.
Crossref   Google Scholar

Marmarosh, C. L., Kivlighan, D. M., Jr. (2012). Relationships among client and counselor agreement about the working alliance, session evaluations, and change in client symptoms using response surface analysis. Journal of Counseling Psychology, 59(3), 352–367. DOI: 10.1037/a0028907.
Crossref   Google Scholar

McWilliams, N. (2018). Diagnoza psychoanalityczna. Gdańsk: GWP.   Google Scholar

Mentovich, A., Rhee, E., Tyler, T. R. (2014). My life for a voice: The influence of voice on health-care decisions. Social Justice Research, 27(1), 99‒117.
Crossref   Google Scholar

Miloff, A., Carlbring, P., Hamilton, W., Andersson, G., Reuterskiöld, L., Lindner, P. (2020). Measuring alliance toward embodied virtual therapists in the era of automated treatments with the Virtual Therapist Alliance Scale (VTAS): Development and psychometric evaluation. Journal of Medical Internet Research, 3(22), e16660. DOI: 10.2196/16660.
Crossref   Google Scholar

Milot-Lapointe, F., Le Corff, Y., Savard, R. (2020). Factor structure of the short version of the Working Alliance Inventory and its longitudinal measurement invariance across individual career counseling sessions. Journal of Career Assessment, 28(4), 693‒705. DOI:10.1177/1069072720925048.
Crossref   Google Scholar

Mokkink, L. B., Prinsen, C. A., Bouter, L. M., de Vet, H. C., Terwee, C. B. (2016). The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Brazilian Journal of Physical Therapy, 20, 105‒113. DOI:10.1590/bjpt-rbf.2014.0143.
Crossref   Google Scholar

Moseley, D. C. (1983). The therapeutic relationship and its association with outcome. Unpublished master’s thesis, University of British Columbia, Vancouver, Canada.   Google Scholar

Munder, T., Wilmers, F., Leonhart, R., Linster, H. W., Barth, J. (2009). Working Alliance Inventory-Short Revised (WAI-SR): psychometric properties in outpatients and inpatients. Clinical Psychology & Psychotherapy, 17, 231–239. DOI: 10.1002/cpp.658.
Crossref   Google Scholar

Muran, J. C., Eubanks, C. F., Samstag, L. W. (2019). The processes of Jeremy Safran. Psychotherapy Research, 29(3), 277–278. DOI: 10.1080/10503307.2018.1562250.
Crossref   Google Scholar

Nissen-Lie, H. A., Solbakken, O. A., Falkenström, F., Wampold, B. E., Holmqvist, R., Ekeblad, A., Monsen, J. T. (2021). Does it make a difference to be more “on the same page”? Investigating the role of alliance convergence for outcomes in two different samples. Psychotherapy Research, 31(5), 573‒588. DOI: 10.1080/10503307.2020.1823030.
Crossref   Google Scholar

Paap, D., Karel, Y. H., Verhagen, A. P., Dijkstra, P. U., Geertzen, J. H., Pool, G. (2022). The Working Alliance Inventory's Measurement Properties: A Systematic Review. Frontiers in Psychology, 13, 1‒19. DOI: 10.3389/fpsyg.2022.945294.
Crossref   Google Scholar

Paap, D., Schepers, M., Dijkstra, P. U. (2020). Reducing ceiling effects in the Working Alliance Inventory-Rehabilitation Dutch Version. Disability and Rehabilitation, 42(20), 2944–2950. DOI:10.1080/09638288.2018.1563833.
Crossref   Google Scholar

Pérez-Arechaederra D. (2019). The psychology of perceived justice in shared health care decision making. W: J. Jackson, K. Pósch (red.), Social psychology and justice (s. 284‒294). London: Routledge.
Crossref   Google Scholar

Perdrix, S., de Roten, Y., Kolly, S., Rossier, J. (2010). The psychometric properties of the WAI in a career counseling setting: Comparison with a personal counseling sample. Journal of Career Assessment, 18(4), 409‒419. DOI:10.1177/1069072710374583.
Crossref   Google Scholar

Petek, D., Pušnik, A., Selič, P., Cedilnik-Gorup, E., Trontelj, Ž., Riou, M., Le Reste, J. Y. (2019). Semantic and cultural equivalence of the working alliance inventory short-revised scale for therapeutic alliance in family medicine: Lessons learned in Slovenia. Slovenian Journal of Public Health, 58(1), 21‒30. DOI: 10.2478/sjph-2019-0003.
Crossref   Google Scholar

Prusiński, T. (2020). Szacowanie przymierza terapeuty i pacjenta w procesie indywidualnej psychoterapii. Adaptacja i właściwości psychometryczne Skali Przymierza w Działaniu (WAI). Badania wstępne. Polskie Forum Psychologiczne, 25(3), 352–375. DOI: 10.14656/PFP20200306.   Google Scholar

Prusiński, T. (2021b). Trafność pomiaru kwestionariuszem Przymierza w Działaniu WAI-PC (wersja dla pacjenta) w psychoterapii systemowej osób dorosłych. Dowody z eksperymentu przeprowadzonego metodą zmian nieprzypadkowych. Przegląd Psychologiczny, 64(3), 103‒111. DOI: 10.31648/pp.7333.
Crossref   Google Scholar

Prusiński, T. (2021a). Patients’ and psychotherapists’ combined and separate evaluations of the psychotherapeutic relationship: the structure of working alliance and polish versions of the WAI. Journal of Contemporary Psychotherapy, 51(4), 323‒329. DOI: 10.1007/s10879-021-09500-z.
Crossref   Google Scholar

Prusiński, T. (2022). The Role of Doctor’s Authority in Patients’ Treatment Decisions. American Journal of Health Behavior, 46(5), 503‒514. DOI: 10.5993/AJHB.46.5.2.
Crossref   Google Scholar

Rogers, C. R. (1951). Client-centered therapy. Cambridge, MA: Riverside Press.   Google Scholar

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 22, 95‒1103.
Crossref   Google Scholar

Santirso, F. A., Martín-Fernández, M., Lila, M., Gracia, E., Terreros, E. (2018). Validation of the Working Alliance Inventory–Observer Short Version with male intimate partner violence offenders. International Journal of Clinical and Health Psychology, 18(2), 152–161. DOI:10.1016/j.ijchp.2018.02.003.
Crossref   Google Scholar

Toste, J. R., Heath, N. L., McDonald Connor, C., Peng, P. (2015). Reconceptualizing teacher-student relationships: Applicability of the working alliance within classroom contexts. The Elementary School Journal, 116(1), 30‒48. DOI: 10.1086/683110.
Crossref   Google Scholar

Tyler, T. R. (2021). Why people obey the law. Princeton University Press.
Crossref   Google Scholar

Tryon, G. S., Blackwell, S. C., Hammel, E. F. (2007). A metaanalytic examination of client–therapist perspectives of the working alliance. Psychotherapy Research, 17, 629–642. DOI: 10.1080/10503300701320611.
Crossref   Google Scholar

Warlick, C., Richter, K. P., Catley, D., Gajewski, B. J., Martin, L. E., Mussulman, L. M. (2019). Two brief valid measures of therapeutic alliance in counseling for tobacco dependence. Journal of Substance Abuse Treatment, 86, 60‒64. DOI: 10.1016/j.jsat.2017.12.010.
Crossref   Google Scholar


Published
2022-12-31

Cited by

Prusiński, T. (2022). Mutual agreement between the patient and the psychotherapist in psychotherapy. Psychometrics value and factor structure of the Working Alliance Inventory . The Review of Psychology, 65(4), 31–56. https://doi.org/10.31648/przegldpsychologiczny.8671

Tomasz Prusiński 
Pracownia Testów Psychologicznych, Instytut Psychologii, Akademia Pedagogiki Specjalnej w Warszawie
https://orcid.org/0000-0002-8782-1498