Using Therapeutic Alliance to Predict Treatment Attendance Among Couples

Validation of the Working Alliance Inventory- Short Form for Patient (WAI-S-P) in Peruvian Adults

Background

Although the importance of the therapeutic alliance in the treatment process and health outcomes is recognized, so far, there has been no evaluation in the Peruvian context that considers possible individual differences that could influence this assessment.

Purpose

This study assessed the psychometric properties of the WAI-S-P in a sample of individuals from Peru who are receiving psychological therapy. Furthermore, a network analysis was conducted to investigate the direct relationships between the therapeutic alliance and several relevant sociodemographic variables.

Methods

The short version of the Working Alliance Inventory was used in a sample of 241 participants (Mage=32.58, SD=12.67) that had attended less than 6 sessions. Three models were considered, including a three-factor and a two-factor correlated model, as well as a bifactor model. In addition, a network of partial associations was created including the overall therapeutic alliance, sex, age, and number of psychotherapeutic sessions.

Results

The bifactor model, with an overall therapeutic alliance factor and two specific factors ("contact" and "contract"), better fit the data. Invariance of the structure by sex and age showed equitable measurement. On the other hand, network analysis revealed a positive correlation between total session attendance and therapeutic alliance. Men reported higher therapeutic alliance, while women had higher total session attendance.

Conclusion

The results of this study suggest that the therapeutic alliance is better represented by a bifactor model and demonstrates invariance across sex and age in Peruvian adults. Additionally, findings indicate that differences in life experiences and the sex of patients may need to be verified in future studies to better understand nuanced needs in forming therapeutic alliances at least in the early stages of session attendance.

Therapists' confidence in their theory of change and outcomes

Previous research has sought to understand what therapist characteristics contribute to positive outcomes for clients. It is widely accepted knowledge that the alliance between the therapist and client is a significant contributing factor to client outcomes. With that said, few studies have examined specific characteristics within the therapist themselves that may contribute to client success, regardless of the therapeutic model being used. Using data from a sample of therapist-trainees at a large, midwestern institution, this study sought to explore therapist confidence in their theory of choice and its potential impact on client outcomes. Findings suggest that those clients who have therapists with greater confidence in their theory are less likely to terminate treatment prematurely or without agreement. These findings have the potential to inform the curriculum for training programs to focus more on developing confidence in the chosen theory.