Adaptation of the working alliance inventory for the assessment of the therapeutic alliance in genetic counseling

Abstract

The concept of therapeutic alliance is central to genetic counseling as the mechanism through which the outcomes of empowerment and effective coping are likely to be achieved. To date, there have been no published systematic assessments of the therapeutic relationship in genetic counseling. We adapted a previously validated measure of the therapeutic alliance to genetic counseling and assessed its reliability and validity. Participants were enrolled in a clinical genomic study where they were randomized to receive education about carrier results via a Web platform or via a genetic counselor and then further randomized to receive genetic counseling (without additional education) or not. We rated the therapeutic alliance from audio recordings of 120 genetic counseling sessions. We modified the observer version of the Working Alliance Inventory (WAI‐O), initially designed to assess therapeutic relationships in psychotherapy. We examined internal consistency reliability by calculating Cronbach's alpha and inter‐rater reliability through both percent agreement and Gwet's alternative agreement coefficient (AC). Regression analyses were used to evaluate the relationship of WAI‐O scores with session length and with the designation of the session as one in which prior education was delivered by the genetic counselor or not. The adapted scale had high‐reliability characteristics with agreement of 88%‐93%, Gwet's AC of 0.84‐0.90, and Cronbach's alpha of 0.89‐0.93 for the three WAI‐O subscales (bonds, goals, and tasks). Although there was no difference in alliance based on whether prior education was provided by the genetic counselor, the total WAI‐O score significantly increased with increasing session length (beta =0.667, p<.001), providing preliminary evidence of construct validity. The WAI‐O that we have adapted can be used reliably with two independent raters to assess the therapeutic alliance in studies of genetic counseling. The initial evidence for construct validity is promising and should be reassessed in future genetic counseling studies using the WAI‐O.

Rapid Implementation of Telegenetic Counseling in the COVID-19 and Swedish Healthcare Context: A Feasibility Study

“…Another reason could be that patients improved their understanding and sense of control through visual interactions such as visual aids, body language, facial expressions, or reading lips, a hypothesis supported by Voils et al (45) that patients appreciate seeing the counselors body language. This explanation fits well with the Theory on therapeutic alliance; seeing the other person creates a rapport and relationship, which are both considered necessary for effective genetic counseling (46), smiliarly reported in at least one other mid-Covid study on TGC (5). The therapeutic alliance requires a positive, safe relationship between patient and provider, which is made easier by seeing one another.…”

“…The therapeutic alliance requires a positive, safe relationship between patient and provider, which is made easier by seeing one another. To understand this phenomenon larger studies are necessary to compare empowerment outcomes between telephone, video and face-to-face genetic counseling, and to assess the therapeutic alliances using for example the working alliance inventory (46).…”

Strength of the genetic counselor: patient relationship is associated with extent of increased empowerment in patients with arrhythmogenic cardiomyopathy

“…Martin and colleagues performed a meta‐analysis of most scales used to assess this alliance and found the Working Alliance Inventory (WAI‐SR) developed in 1989 to be an appropriate and useful measure (Martin et al., 2000). The WAI‐SR client form has not previously been utilized in the GC field; however, recently, the observer form was adapted for use in GC (Erby et al., 2021).…”

Alfabetización genética en cuidadores frente a un asesoramiento genético pediátrico, en un hospital público de Buenos Aires

“…La información objetiva que se le brinda al paciente es solo un aspecto dentro del complejo fenómeno que implica la comprensión de información genética y la toma de decisiones (Tibben y Biesecker, 2019). Por ello, otras variables comenzaron a tener relevancia dentro de las investigaciones actuales, como son: la incertidumbre, la necesidad de un cierre (Tibben y Biesecker, 2019) y la alianza terapéutica que se establece en la relación médico-paciente (Erby et al, 2021).…”

“…Algunas de las publicaciones más recientes plantean, incluso, modelos de abordaje específicos. Erby et al (2021) consideran que la práctica del asesoramiento genético está basada en la tradición psicoterapéutica centrada en la persona, de Rogers, debido al papel de la alianza terapéutica y el foco en la atención centrada en el paciente durante este proceso. Vázquez et al (2021) propone brindar acompañamiento psicoeducativo, breve y focalizado a las familias, en tres momentos claves: búsqueda del diagnóstico, comunicación del diagnóstico y adherencia al tratamiento.…”