Patient-Therapist Perspective of the Working Alliance in Psychotherapy

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.

The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross‐sectional study in acute mental health units

“…Conversely, the lower association found within the bonding dimension could be attributed to its inherent complexity and the challenges it poses in terms of assessment, especially during the initial phases of the relationship, producing greater variability in perceptions between nurses and patients (Atzil‐Slonim et al, 2015). These results are in line with other studies in psychotherapy, which found significant associations between tasks and/or goals (Andrade‐González et al, 2017; Beaudette et al, 2020; Evans‐Jones et al, 2009; Luong et al, 2020). Moreover, the age of the nurse has a negative impact on the patients' perception of the quality of the TR, possibly due to professional burnout and its negative consequences on the TR and quality of care (Friganović, 2017; Torres Campuzano, 2018).…”

“…These results are consistent with another study conducted in the mental health inpatient setting where physician ratings were higher than those of patients (Beaudette et al, 2020). However, in the community setting, the opposite has been found, with higher scores assigned by patients compared to therapists (Andrade‐González et al, 2017; Hartmann et al, 2015; Igra et al, 2020; Penix et al, 2021). These differences could be attributed to the specific care environment under examination.…”

“…These differences could be attributed to the specific care environment under examination. It is possible that the development of the TR takes time, with initial days of hospitalization marked by its nascent stages, subsequently leading to an improvement in perceptions of TR quality over time (Andrade‐González et al, 2017; Tschuschke et al, 2020) and a consequent reduction in differences between professional and patient assessments (Coyne et al, 2018). In addition, patients were found to perceive low therapeutic communication, reflecting poor empathy on behalf of the nurses (Saavedra Chinchayán et al, 2021) and emphasizing the importance of establishing a bond of trust during the first 24–72 h of hospitalization to understand their needs and expectations (Moreno‐Poyato, El Abidi, et al, 2021).…”

Spanish Versions of the Outcome Rating Scale and the Session Rating Scale: Normative Data, Reliability, and Validity

“…Also, these correlations were similar to those found by Moggia et al (2020) and higher than those found by Janse et al (2014) in the Netherlands and by Duncan et al (2003) in the SRS creation study (see Table 4). The fact that in Spain the correlations were not high between the perceived alliance scores of patients on the SRS and those of the therapists on the WAI-S-T is in line with the moderate results of the studies that have examined patients' and clinicians' perceptions of the alliance (Tryon et al, 2007;Andrade-González et al, 2017). On the other hand, the discriminant validity of the Spanish ORS and SRS was adequate, since, as expected, their scores diverged from the scores of measures that evaluate other constructs and from a variable related neither to the patients' symptomatology nor to the working alliance.…”