Only connect: The working alliance in computer-based cognitive behavioral therapy

Abstract

The limited role of therapists in some technology-based interventions raises questions as to whether clients may develop a ‘working alliance’ with the program, and the impact on relationships with a therapist and/or treatment outcomes. In this study, the Working Alliance Inventory (WAI), and an adapted version for technology-based interventions (WAI-Tech), were administered within a subsample (n = 66) of cocaine-dependent individuals participating in a randomized trial evaluating the efficacy of Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) as an adjunct to treatment as usual (TAU). Results suggest the WAI-Tech has relatively similar psychometric characteristics as the standard WAI; however the ‘bond’ subscale scores were lower on the WAI-Tech [F(1,52) = 5.78, p<.05]. Scores on the WAI-Tech were not associated with cocaine use outcomes, whereas total scores on the WAI for those assigned to TAU were associated with the percentage of days abstinent from cocaine (r = .43, p < .05). There was little evidence that adding a technology-based intervention adversely affected the working alliance with a therapist in this sample. These preliminary findings suggest some concepts of working alliance may apply to computer-based CBT, yet the function of the alliance may be different in technology-based interventions than in face-to-face psychotherapies.

Alexithymia level and response to computer-based training in cognitive behavioral therapy among cocaine-dependent methadone maintained individuals

“…Alexithymia level was not associated with differences in participant measures of alliance with their methadone treatment program clinician (WAI-C). Within the group assigned to CBT4CBT, TAS-20 scores were not significantly associated with completion of CBT4CBT modules, homework assignments or reported ‘alliance’ with CBT4CBT as measured by the adapted WAI-Tech (Kiluk et al, 2014). Although we had predicted poorer treatment adherence among those with higher alexithymia, these findings are in line with other data suggesting that individuals with alexithymia do not necessarily avoid treatment (Ogrodniczuk et al, 2009).…”

“…The Emotion Regulation Questionnaire (Gross and John, 2003) was used to assess ability to both reappraise and suppress emotions. The client version of the Working Alliance Inventory (WAI-C; Horvath, 1989), as well as an adapted version of the WAI for use in assessing technology based interventions (Kiluk et al, 2014), were used to evaluate the perceived working relationship with participants’ methadone program clinicians and the CBT4CBT intervention, respectively.…”

The Working Alliance Inventory for guided Internet interventions (WAI‐I)

“…Recently, Kiluk, Serafini, Frankforter, Nich, and Carroll () have presented an adaptation of the WAI (Horvath & Greenberg, ) for technology‐based interventions (WAI‐Tech), based on the 36‐item original version. In the WAI‐Tech most of the items corresponding to the task and goals subscales of the WAI remained unmodified (i.e., the only change in these items was to replace the name of the therapist by the online program).…”

“…However, the items of the bond subscale were mostly adjusted, replacing the wording to refer to the attachment to the online program. Although the study by Kiluk et al () represented an advance toward improving the measuring of working alliance for Internet interventions, the small sample size of the study ( n = 34) limited the possibility of draw sound inferences regarding the psychometric properties of the measure. Additionally, the instrument was only focused on exploring the alliance with an unguided computerized program without taking into account the relational aspects involved in guided Internet interventions.…”

Recovery benefits of the “therapeutic alliance” among 12-step mutual-help organization attendees and their sponsors

“…In both the general psychotherapy (Horvath and Luborsky, 1993; Wampold, 2001) and addiction-specific treatment literature (Beutler et al, 1994; Kiluk et al, 2014; Moos, 2007; Urbanoski et al, 2012), the “therapeutic alliance” is viewed as an essential factor in treatment. This working relationship between therapist and patient is purported to create the necessary climate and conditions in which other intervention contents, from whichever specific theoretical orientation, can be successfully delivered by the therapist and absorbed by the patient (Kelly et al, 2016; Luborsky et al, 1988; Miller and Moyers, 2015; Wampold, 2001).…”