Development and validation of the Working Alliance Inventory Dutch version for use in rehabilitation setting

Background: In rehabilitation, therapeutic alliance is associated with improvements in clinical outcomes. The Working Alliance Inventory (WAI) measures therapeutic alliance and is frequently used in rehabilitation research; however, it has not been validated for rehabilitation. Objectives: To determine content validity, internal consistency and construct validity of the Working Alliance Inventory Rehabilitation Dutch Version (WAI-ReD). Methods: In phase 1, content and face validity of the WAI-ReD was judged by professionals (n = 15) and in phase 2 by patients (n = 22). In phase 3, 14 hypotheses were tested in patients (n = 138) regarding: content validity (i.e., missing items, floor, and ceiling effects); internal consistency; and construct validity (i.e., factor structural testing correlations of WAI-ReD scores with Session Rating Scale (SRS), the Helping Alliance Questionnaire II (HAQ-II), and Visual Analog Scale of Pain (VAS(pain))). Results: After phase 1 and phase 2, the WAI-ReD was formulated and tested. Content validity; missing items were negligible. Ceiling effects were present in all domains. Internal consistency; Cronbach's alpha ranged between 0.804 and 0.927. Construct validity; correlations between WAI-ReD, SRS, HAQ-II, and VAS(pain) fell within the hypothesized ranges. Conclusion: Eleven of the 14 hypotheses were not rejected confirming good clinimetric properties of the WAI-ReD. The WAI-ReD can be used in rehabilitation to measure therapeutic alliance

Sudden gains in the treatment of obsessive-compulsive disorder

Background: The present study examined sudden gains during treatment for obsessive-compulsive disorder (OCD) and their relationship to short-and long-term outcome. Methods: Ninety-one individuals (age 19-64) completed either cognitive treatment, exposure treatment, or their combination with fluvoxamine for OCD. Participants' obsessive-compulsive symptoms were assessed before each weekly treatment session. In addition, obsessive-compulsive and depressive symptoms were assessed pre treatment and post treatment as well as 12 months following treatment termination. Results: Sudden gains were found among 34.1% of participants and constituted 65.5% of the total reduction in obsessive-compulsive symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of OCD symptoms post treatment, and this was maintained during follow-up. Conclusions: Sudden gains are common in treatments for OCD and are predictive of treatment outcome and follow-up. Sudden gains mark a distinct trajectory of response to treatment for OCD. Individuals with sudden gains greatly improve during treatment and maintain their gains during follow-up, whereas individuals without sudden gains improve to a significantly lesser extent. Thus, treatment planning and development can benefit from considering sudden gains and the intra-individual course of improvement. © 2011 S. Karger AG, Basel

Therapeutic Alliance and Alliance Ruptures and Resolutions: Theoretical Definitions, Assessment Issues, and Research Findings

none2noTherapeutic alliance is one of the most impor- tant and investigated constructs in psychother- apy research. In this chapter we first discuss the historical development of therapeutic alli- ance, from psychoanalytic theory to empirical research, and then its measurement and the problematic issues related to it. Then we will focus our discussion on the therapeutic alli- ance ruptures and resolutions construct, which represents one of the most interesting but, at the same time, controversial issues of contem- porary therapeutic alliance research. Finally we propose a brief research agenda about therapeutic alliance ruptures and resolutions.mixedLingiardi, V.; Colli, A.Lingiardi, V.; Colli, Antonell