Validation of the working alliance inventory | PPA

Data Sharing Statement

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

1. Elvins R, Green J. The conceptualization and measurement of therapeutic alliance: an empirical review. Clin Psychol Rev. 2008;28(7):1167–1187. doi:10.1016/j.cpr.2008.04.002

2. Anderson RP, Anderson GV. Development of an instrument for measuring rapport. Pers Guid J. 1962;41(1):18–24. doi:10.1002/j.2164-4918.1962.tb02226.x

3. Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy. 1979;16(3):252–260. doi:10.1037/h0085885

4. Luborsky L, Crits-Christoph P, Alexander L, Margolis M, Cohen M. Two helping alliance methods for predicting outcomes of psychotherapy. A counting signs vs. a global rating method. J Nerv Ment Dis. 1983;171(8):480–491. doi:10.1097/00005053-198308000-00005

5. Luis Botella SC. Alianza terapéutica evaluada por el paciente y mejora sintomática a lo largo del proceso terapéutico. Boletín Psicol. 2011;101:21–33.

6. Corbella S, Botella L, Gómez AM, Herrero O, Pacheco M. Psychometric characteristics of the Spanish version of the Working Alliance Inventory-Short (WAI-S). An Psicol Ann Psychol. 2011;27(2):298–301.

7. Impala T, Dobson KS, Kazantzis N. Does the working alliance mediate the therapist competence-outcome relationship in cognitive behavior therapy for depression? Psychother Res. 2022;32(1):16–28. doi:10.1080/10503307.2021.1946195

8. Misdrahi D, Petit M, Blanc O, Bayle F, Llorca PM. The influence of therapeutic alliance and insight on medication adherence in schizophrenia. Nord J Psychiatry. 2012;66(1):49–54. doi:10.3109/08039488.2011.598556

9. Keller SM, Zoellner LA, Feeny NC. Understanding Factors associated with early therapeutic alliance in PTSD treatment: adherence, childhood sexual abuse history, and social support. J Consult Clin Psychol. 2010;78(6):974. doi:10.1037/a0020758

10. Pihlaja S, Stenberg JH, Joutsenniemi K, Mehik H, Ritola V, Joffe G. Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders – A systematic review. Internet Interv. 2017;11:1–10. doi:10.1016/j.invent.2017.11.005

11. Bedics JD, Atkins DC, Harned MS, Linehan MM. The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy. 2015;52(1):67–77. doi:10.1037/a0038457

12. van Benthem P, Spijkerman R, Blanken P, Kleinjan M, Vermeiren RRJM, Hendriks VM. A dual perspective on first-session therapeutic alliance: strong predictor of youth mental health and addiction treatment outcome. Eur Child Adolesc Psychiatry. 2020;29(11):1593–1601. doi:10.1007/s00787-020-01503-w

13. Zaitsoff S, Pullmer R, Cyr M, Aime H. The role of the therapeutic alliance in eating disorder treatment outcomes: a systematic review. Eat Disord. 2015;23(2):99–114. doi:10.1080/10640266.2014.964623

14. Wheaton MG, McIngvale E, Van Meter AR, Björgvinsson T. Quality of the therapeutic working alliance as a factor in intensive residential treatment of obsessive-compulsive disorder. Psychother Res. 2023;33(4). doi:10.1080/10503307.2022.2138618

15. Murphy ST, Garcia RA, Cheavens JS, Strunk DR. The therapeutic alliance and dropout in cognitive behavioral therapy of depression. Psychother Res. 2022;32(8):995–1002. doi:10.1080/10503307.2021.2025277

16. Sharf J, Primavera LH, Diener MJ. Dropout and therapeutic alliance: a meta-analysis of adult individual psychotherapy. Psycho Theory Res Pract Train. 2010;47(4):637–645. doi:10.1037/a0021175

17. Moshe-Cohen R, Kivity Y, Huppert JD, et al. Agreement in patient-therapist alliance ratings and its relation to dropout and outcome in a large sample of cognitive behavioral therapy for panic disorder. Psychother Res. 2022;2022:1–3.

18. Weck F, Grikscheit F, Jakob M, Höfling V, Stangier U. Treatment failure in cognitive-behavioural therapy: therapeutic alliance as a precondition for an adherent and competent implementation of techniques. Br J Clin Psychol. 2015;54(1):91–108. doi:10.1111/bjc.12063

19. Bartle-Haring S, Walsh L, Blalock J, Bryant A. using therapeutic alliance to predict treatment attendance among couples. Contemp Fam Ther. 2021;43(4):370–381. doi:10.1007/s10591-021-09602-9

20. Fayed C, Bartle-Haring S, VanBergen A. Interpersonal Trauma, therapeutic alliance and relationship satisfaction: a dyadic examination. Contemp Fam Ther. 2021;1–14. doi:10.1007/s10591-021-09595-5

21. Thompson SJ, Bender K, Lantry J, Flynn PM. Treatment engagement: building therapeutic alliance in home-based treatment with adolescents and their families. Contemp Fam Ther. 2007;29(1–2):39. doi:10.1007/s10591-007-9030-6

22. Lin T, Anderson T, Austin M, Mischkowski D. Early trajectories of symptom change and working alliance as predictors of treatment outcome. Psychother Res. 2023;33(2):185–197. doi:10.1080/10503307.2022.2080028

23. Doorn K A-V, Bar-Sella A, Zilcha-Mano S, et al. Within-patient perceptions of alliance and attunement: associations with progress in psychotherapy. Clin Psychol Psychother. 2022;29(5):1717–1727. doi:10.1002/cpp.2737

24. Nam SK, Chu HJ, Lee MK, Lee JH, Kim N, Lee SM. A meta-analysis of gender differences in attitudes toward seeking professional psychological help. J Am Coll Health. 2010;59(2):110–116. doi:10.1080/07448481.2010.483714

25. Saunders R, Buckman JEJ, Stott J, et al. Older adults respond better to psychological therapy than working-age adults: evidence from a large sample of mental health service attendees. J Affect Disord. 2021;294:85–93. doi:10.1016/j.jad.2021.06.084

26. Herrero R, Vara MD, Miragall M, et al. Working alliance inventory for online interventions-short form (WAI-TECH-SF): the role of the therapeutic alliance between patient and online program in therapeutic outcomes. Int J Environ Res Public Health. 2020;17(17):1–16. doi:10.3390/ijerph17176169

27. Behn A, Davanzo A, Errázuriz P. Client and therapist match on gender, age, and income: does match within the therapeutic dyad predict early growth in the therapeutic alliance? J Clin Psychol. 2018;74(9):1403–1421. doi:10.1002/jclp.22616

28. Kim HS, Munson MR, McKay MM. Engagement in mental health treatment among adolescents and young adults: a systematic review. Child Adolesc Soc Work J. 2012;29(3):241–266. doi:10.1007/s10560-012-0256-2

29. Van Der Heijden B, Mahoney CB, Xu Y. Impact of job demands and resources on nurses’ burnout and occupational turnover intention towards an age-moderated mediation model for the nursing profession. Int J Environ Res Public Heal. 2019;16(11):2011. doi:10.3390/ijerph16112011

30. Seidler ZE, Rice SM, Ogrodniczuk JS, Oliffe JL, Dhillon HM. Engaging men in psychological treatment: a scoping review. Am J Mens Health. 2018;12(6):1882–1900. doi:10.1177/1557988318792157

31. José F, Javier F, Paz M. Sistema de Información Científica A study of patients who go to a psychology clinic seeking treatment. Span J Psychol. 2012;15(1):275–285. doi:10.5209/rev_SJOP.2012.v15.n1.37334

32. Bedi RP, Richards M. What a man wants: the male perspective on therapeutic alliance formation. Psychotherapy. 2011;48(4):381–390. doi:10.1037/a0022424

33. Ribeiro NS, Colugnati FAB, Kazantzis N, Sartes LMA. Observing the working alliance in videoconferencing psychotherapy for alcohol addiction: reliability and validity of the Working Alliance Inventory short revised observer. Front Psychol. 2021;12:647814. doi:10.3389/fpsyg.2021.647814

34. Horvath AO, Greenberg LS. Development and Validation of the Working Alliance Inventory. J Couns Psychol. 1989;36(2):223–233. doi:10.1037/0022-0167.36.2.223

35. Horvath AO, Luborsky L. The role of the therapeutic alliance in psychotherapy. J Consult Clin Psychol. 1993;61(4):561–573. doi:10.1037/0022-006X.61.4.561

36. Tracey TJ, Kokotovic AM. Factor Structure of the Working Alliance Inventory. Psychol Assess. 1989;1(3):207–210. doi:10.1037/1040-3590.1.3.207

37. Paap D, Karel YH, Verhagen AP, Dijkstra PU, Geertzen JHB, Pool G. The Working Alliance Inventory’s measurement properties: a systematic review. Front Psychol. 2022;13. doi:10.3389/fpsyg.2022.945294

38. Hukkelberg S, Ogden T. General and specific factors of working alliance in parent training: a bifactor exploratory structural equation modelling approach. Psychother Res. 2019;29(2):267–276. doi:10.1080/10503307.2017.1330574

39. Milot-Lapointe F, Le Corff Y, Savard R. Factor Structure of the short version of the Working Alliance Inventory and its longitudinal measurement invariance across individual career counseling sessions. J Career Assess. 2020;28(4):693–705. doi:10.1177/1069072720925048

40. Gülüm IV, Uluç S, Soygüt G. Psychometric properties of the Turkish Working Alliance Inventory – Short form. Turk Psikiyatr Derg. 2018;29:1.

41. Prusiński T. Patients’ and psychotherapists’ combined and separate evaluations of the psychotherapeutic relationship: the structure of Working Alliance and Polish Versions of the WAI. J Contemp Psychother. 2021;51(4):323–329. doi:10.1007/s10879-021-09500-z

42. Li X, Zhao H, Wu M, Li F, Hill CE. 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. J Couns Psychol. 2023;70(2). doi:10.1037/cou0000655

43. Leangsuksant T, Taephant N. Development and validation of the Working Alliance Inventory short form Thai client version. Asia Pacific J Couns Psychother. 2022;13(1):40–52.

44. Stefens M, Rondeel E, Templin J, et al. Longitudinal measurement invariance of the Working Alliance Inventory – Short form across coaching sessions. BMC Psychol. 2022;10(1):1–13. doi:10.1186/s40359-022-00968-5

45. Takasaki H, Miki T, Hall T. Development of the Working Alliance Inventory-Short Form Japanese version through factor analysis and test-retest reliability. Physiother Theory Pract. 2020;36(3):444–449. doi:10.1080/09593985.2018.1487492

46. Smits D, Luyckx K, Smits D, Stinckens N, Claes L. Structural characteristics and external correlates of the Working Alliance Inventory-Short Form. Psychol Assess. 2015;27(2):545–551. doi:10.1037/pas0000066

47. Oudshoorn CEM, Frielink N, Riper H, Embregts PJCM. Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability. J Intellect Disabil Res. 2023;67(1):49–63. doi:10.1111/jir.12986

48. Graves TA, Tabri N, Thompson-Brenner H, et al. A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders. Int J Eat Disord. 2017;50(4):323–340. doi:10.1002/eat.22672

49. Hsu S, Zhou RD-H, Yu -CK-C. A Hong Kong validation of Working Alliance Inventory – short form – client. Asia Pacific J Couns Psychother. 2016;7(1–2):69–81.

50. Otzen T, Manterola C. Sampling Techniques on a Population Study. Int J Morphol. 2017;35(1):227–232. doi:10.4067/S0717-95022017000100037

51. Ramos-Vera CA, Ramos-Vera CA. A sample size calculation method for a priori power analysis in structural equation models. Rev Cuerpo Med Hosp Nac Almanzor Aguinaga. 2021;14(1):104–105.

52. Andrade-González N, Fernández-Liria A. Spanish Adaptation of the Working Alliance Inventory (WAI): psychometric properties of the patient and therapist forms (WAI-P and WAI-T). An Psicol. 2015;31(2):524–533. doi:10.6018/analesps.31.2.177961

53. Mayaute LME. Cuantificación de la validez de contenido por criterio de jueces. Rev Psicol. 1988;6(1–2):103–111.

54. Pérez ER, Medrano L. Exploratory factor analysis: conceptual and methodological bases. Rev Argent Cienc Comport. 2010;2(1):58–66.

55. Dominguez-Lara S, Rodriguez A. Statistical indices of bifactor models. Interacciones Rev Av en Psicol. 2017;3(2):59–65.

56. Dueber DM. Bifactor Indices calculator: a Microsoft Excel-based tool to calculate various indices relevant to bifactor CFA models. Educ Sch Couns Psychol Res Tools. 2017;2017:1.

57. Forero CG, Maydeu-Olivares A, Gallardo-Pujol D. Factor analysis with ordinal indicators: a monte carlo study comparing DWLS and ULS estimation. Struct Equ Model a Multidiscip J. 2009;16(4):625–641. doi:10.1080/10705510903203573

58. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equ Model a Multidiscip J. 2009;6(1):1–55.

59. Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equ Model. 2007;14(3):464–504. doi:10.1080/10705510701301834

60. Viladrich C, Angulo-Brunet A, Doval E. A journey around alpha and omega to estimate internal consistency reliability. An Psicol. 2017;33(3):755–782. doi:10.6018/analesps.33.3.268401

61. Ramos-Vera C. Statistical relationship networks in nutrition research. Nutr Hosp. 2021;38:671–672. doi:10.20960/nh.03522

62. Ramos-Vera C, Barrientos AS, Baños-Chaparro J, Saldarriaga JV, Saintila J. Enneagram typologies and healthy personality to psychosocial stress: a network approach. Front Psychol. 2022;13:7517. doi:10.3389/fpsyg.2022.1051271

63. Borsboom D, Robinaugh DJ, Rhemtulla M, Cramer AOJ. Robustness and replicability of psychopathology networks. World Psychiatry. 2018;17:143–144. doi:10.1002/wps.20515

64. Freiberg Hoffmann A, Stover JB, De la Iglesia G, Fernández Liporace M. Development of an instrument for measuring rapport Polychoric and tetrachoric correlations in exploratory and confirmatory factorial studies. Ciencias Psicológicas. 2013;151–164. doi:10.22235/cp.v7i1.1057

65. Rodriguez A, Reise SP, Haviland MG. Applying bifactor statistical indices in the evaluation of psychological measures. J Pers Assess. 2016;98(3):223–237. doi:10.1080/00223891.2015.1089249

66. Corbière M, Bisson J, Lauzon S, Ricard N. Factorial validation of a French short-form of the Working Alliance Inventory. Int J Methods Psychiatr Res. 2006;15(1):36–45. doi:10.1002/mpr.27

67. Wintersteen MB, Mensinger JL, Diamond GS. Do gender and racial differences between patient and therapist affect therapeutic alliance and treatment retention in adolescents? Prof Psychol Res Pract. 2005;36(4):400–408. doi:10.1037/0735-7028.36.4.400

68. Wendt D, Shafer K. Gender and attitudes about mental health help seeking: results from national data. Health Soc Work. 2016;41(1):e20–8. doi:10.1093/hsw/hlv089

69. Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC Fam Pract. 2016;17(1):1–7. doi:10.1186/s12875-016-0440-0

70. Knight BG, Poon CYM. Contextual adult life span theory for adapting psychotherapy with older adults. J Ration Cogn Ther. 2008;26(4):232–249. doi:10.1007/s10942-008-0084-7

71. Tiemens B, Kloos M, Spijker J, Ingenhoven T, Kampman M, Hendriks GJ. Lower versus higher frequency of sessions in starting outpatient mental health care and the risk of a chronic course; a naturalistic cohort study. BMC Psychiatry. 2019;19(1):228. doi:10.1186/s12888-019-2214-4

72. Kielmann K, Vidal N, Riekstina V, et al. “Treatment is of primary importance, and social assistance is secondary”: a qualitative study on the organisation of tuberculosis (TB) care and patients’ experience of starting and staying on TB treatment in Riga, Latvia. PLoS One. 2018;13(10):e0203937. doi:10.1371/journal.pone.0203937

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