The development of a Brief Working Alliance Inventory for clients and therapists using multilevel factor analysis and item response theory in the United States and China.

Abstract

This study aimed to investigate the multilevel factor structure of the therapist and client versions of the 12-item Working Alliance Inventory-Short Revised (WAI; Hatcher & Gillaspy, 2006) in the United States and China, and to create a three-item brief version (WAI-B3) using multilevel factor analysis (M-FA) and multilevel item response theory (M-IRT). We gathered eight data sets from two samples each in United States and China with a total of 21,623 sessions from 376 therapists and 2,455 clients. M-FA results with the first four data sets (two American and two Chinese) suggested that the 12-item WAI across therapist and client versions, and in both United States and China showed a dominant general WA factor with three specific subgroup factors corresponding to the Goal, Task, and Bond items. We then constructed a three-item WAI-B3 by selecting items 11, 10, and 9 through M-IRT, as the best representative of Goal, Task, and Bond subscales, respectively, for both the therapist and client versions in United States and China. With the other four data sets (two American, two Chinese) to test the WAI-B3, we found adequate multilevel reliability, structural validity, and convergent validity with the original 12-item WAI scores. Multilevel measurement invariance tests provided tentative and mixed support for the equivalence of WAI-B3 between the American and Chinese data sets and between therapist and client versions. We recommend that the WAI-B3 be used in routine clinical practice to track therapy process, and that the WAI-B3 be tested with other client and therapist populations and cultures. Public Significance StatementThe 12-item Working Alliance Inventory-Short Revised (WAI-SR; Hatcher & Gillaspy, 2006) is best represented by a predominant general working alliance factor and its total composite score can be used to describe both between-session changes or conduct between-therapy-dyad comparisons. Items 11, 10, and 9 in WAI-SR form a brief version WAI-B3 that has solid psychometric properties. Measurement equivalence is supported for WAI-B3 client version across United States and China, and across its therapist and client versions in the United States. Mixed support for equivalence is found for WAI-B3-Therapist across United States versus China, and therapist versus client versions in China. It is recommended that researchers and practitioners incorporate this brief WAI-B3 into their routine clinical practice to continuously track both therapist and client perceptions of their working alliance over the treatment and conduct further cross-cultural investigations.

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

“…For example, in Canada, 39 Turkey, 40 and Poland. 41 Recent research also confirms this factorial model in Asian participants from China 42 where favorable results were obtained for the bifactor model, and Thailand, where both the unidimensional and three-dimensional models are plausible, suggesting that both structures are equally valid for explaining the nature of the therapeutic alliance in that context. 43 It has even been observed that the factor structure of the WAI-SP remains invariant over time, ie, it does not vary between different psychotherapeutic sessions.…”

“…43 Regarding reliability, the results showed a coefficient above what was suggested to conclude that the unidimensionality of the WAI-SP would be more appropriate, which coincides with the antecedents. 36,42,43 These findings highlight the importance of considering cultural and contextual differences when investigating the structure of the therapeutic alliance, as there may be variations in how patients perceive and experience the relationship with their therapist.…”

“… 66 In China, favorable results were obtained for the bifactor model, indicating that this model is adequate to describe the structure of the therapeutic alliance in that population. 42 On the other hand, in Thailand, both the unidimensional and three-dimensional models are plausible, suggesting that both structures are equally valid for explaining the nature of the therapeutic alliance in that context. 43 Regarding reliability, the results showed a coefficient above what was suggested to conclude that the unidimensionality of the WAI-SP would be more appropriate, which coincides with the antecedents.…”

Exploring the Impact of Therapeutic Presence on Working Alliance in Metaverse Counseling

“…Working alliance is a collaborative and therapeutic relationship established between a client and a therapist. Working alliance is not only extensively researched but also considered one of the most influential factors contributing to the success of psychotherapy (Doran, 2016; Li et al, 2023). In online spaces, however, it is important to acknowledge that certain sensory experiences, such as smell, taste, and touch, cannot be shared.…”