Examining therapist estimation of client working alliance and client symptom outcome using truth and bias model and response surface analysis.

OBJECTIVE: The aims of this study were to investigate the congruence and discrepancy between Chinese therapist trainees' estimated client working alliance (WA) and their clients' actual WA rating, and how the congruence and discrepancy predicted client symptom outcome. METHODS: Participants were 211 beginning therapist trainees and 1216 clients. Data from their 6888 sessions were analyzed using Truth and Bias Model and Response Surface Model. RESULTS AND CONCLUSIONS: (i) Chinese trainees' estimation of client WA was on average significantly lower than actual client WA. (ii) At the between-person level, whether the trainee generally over- or underestimated client WA was not related to the client's initial symptom level or symptom improvement rate. (iii) At the within-person between-session level, a session where a trainee accurately perceived high client WA, compared to a session where the trainee accurately perceived low client WA, was followed by greater client symptom relief before the next session. In the case of estimation bias, a session where the trainee underestimated client WA was followed by greater client symptom reduction in the next session, rather than the other way around when the trainee overestimated client WA. Implications on therapist training were discussed.

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.

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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring Therapist Self-Efficacy Change Profiles Using Latent Growth Curve Analysis.

OBJECTIVE: This study investigated the overall developmental trajectories of three conceptually progressive aspects of counseling self-efficacy, including helping skills (HS), session management (SM), and counseling challenges (CH), among beginning therapist trainees in China. METHOD: Participants included 103 beginning therapist trainees in a master's level counselor training programme in China, who filled out measures of counselor self-efficacy in three waves over one year of practicum. RESULTS: (a) Trainees showed highest initial level of HS, followed by SM, with CH being the lowest; and there were significant increases in all three aspects of self-efficacy. (b) Trainee age, gender, and personal therapy hours as a client were associated with the overall self-efficacy developmental trajectories. Specifically, elder therapist trainees reported higher initial levels of self-efficacy in HS and CH; female trainees reported lower initial level but higher increases in CH self-efficacy over practicum; and trainees who had more hours of personal therapy as clients showed higher initial levels on HS but not on other aspects or the change trajectories. CONCLUSION: Results in this study may inform trainers regarding trainees' developmental characteristics, and assist them in planning targeted support to better foster trainee progress.