Observing the Working Alliance in Videoconferencing Psychotherapy for Alcohol Addiction: Reliability and Validity of the Working Alliance Inventory Short Revised Observer.

The coronavirus disease-2019 (COVID-19) pandemic has affected the mental health and alcohol consumption of individuals. Videoconferencing psychotherapy has become a fundamental mode of treatment for people with alcohol use disorders. However, there are still doubts about its effectiveness and the therapeutic relationship. The working alliance is considered a foundation of effective practice in cognitive behavioral therapy (CBT). Observer measurements of the working alliance have demonstrated reliability and meaningful associations with the reduction of symptoms. However, translations of instruments to evaluate the working alliance and examine its construct have not previously been conducted for online psychotherapy for alcohol addiction. This study aimed for the cross-cultural adaptation of the Working Alliance Inventory-Short Form-Observer (WAI-SR-O) for Brazil and the evaluation of its reliability and evidence of its validity in videoconferencing psychotherapy for alcoholism. The WAI-SR-O was applied by pairs of observers for the evaluation of the working alliance in 19 recorded sessions of videoconferencing psychotherapy of 10 clients with a diagnosis of alcohol addiction. The sessions were also evaluated by the therapist (WAI-T) and client (WAI-C). The WAI-SR-O shows a moderate inter-rater intraclass correlation coefficient (ICC = 0.67) for the general scale, higher ICC for the goals and bond subscales, and a moderate value for the task subscale. The internal consistency was good (a = 0.86). The results show low but significant correlations among the goals and bond subscales of the WAI-SR-O and the general, goals, and bond scales of the WAI-T. No correlations were found with the WAI-C. As the literature points out, the client, therapist, and observer versions of the WAI evaluated the alliance differently, requiring further study. The WAI-SR-O proved to be a reliable and valid measurement for the evaluation of the working alliance in videoconferencing psychotherapy for alcohol addiction, becoming an important tool for the study of the working alliance in telepsychotherapy.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions

Abstract Introduction Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. Objective To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). Methods The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. Results The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

"Working Alliance Inventory" versión observacional: traducción, adaptación y validación al castellano / Working Alliance Inventory observational form: translation, adaptation and validation to Spanish

La investigación ha demostrado la fuerte relación entre alianza terapéutica y resultados en psicoterapia. Una buena alianza está asociada a mejores resultados en psicoterapia. Para medir alianza se han desarrollado una serie de instrumentos para terapeutas, pacientes, y observadores. Los instrumentos observacionales son menos intrusivos, disminuyendo los posibles efectos que las mediciones tendrían en el tratamiento. Además, han resultado más válido en algunas poblaciones clínicas. En Chile no se cuenta con un instrumento confiable y validado que mida alianza terapéutica desde la perspectiva de un observador. El presente artículo da cuenta de la traducción al castellano, y la adaptación y validación del WorkAlliance Inventory (WAI-0) en su versión observacional para Chile. El (WAI-0) es un instrumento válido y confiable para medir alianza terapéutica.

Research has shown the strong association between therapeutic alliance and therapeutic outcomes. A good alliance is linked with better outcomes in psychotherapy. A number of instruments have been developed to measure the alliance aimed at therapists, patients, and observers. Observational instruments are less intrusive, and reduce the possible effects that measurements may have on treatment. In addition, they have proven to be more valid in some clinical populations. In Chile, there are no reliable and validated instruments to measure the therapeutic alliance from the point of view of an observer. The present article introduces a translation into Spanish along with an adaptation and validation for Chile of the Work Alliance Inventory (WAI-O) in its observational version. WAI-O is a valid and reliable instrument for measuring the therapeutic alliance.

Adaptación de Inventario de Alianza de Trabajo en su Versión Observador: WAI-O-A / Adaptation of the Working Alliance Inventory in its Observer Form: WAI-O-A

El objetivo del presente artículo es presentar las tareas de validación del Inventario de Alianza de Trabajo en su Versión Observador para una muestra de pacientes y terapeutas de la Ciudad Autónoma de Buenos Aires. Para ello se detallan las diferentes tareas realizadas a in de obtener datos sobre los distintos tipos de validez (teórica o estructural, concurrencia y de constructo) involucrados en el proceso general de validación. Se presentan los resultados estadísticos asociados al estudio de la validez de constructo.

The aim of the present paper is to present the tasks for the validation of the Working Alliance Inventory in its Observer Form, in a sample of patients and psychotherapists of Buenos Aires. The different tasks made in order to obtain the data about the different types of validity (theoretical or structural, concurrent and construct) involved in the general validation process are detailed. Statistical results related to the study of construct validity are presented.

Descripción de observables clínicos y de cambios en el proceso de admisión y de su impacto en el inicio del tratamiento psicoterapéutico / Description of observable clinical and of changes in the process of admission and of their impact in the beginning of the therapeutic treatment

Este estudio está enfocado en el proceso de admisión de 30 consultantes. El proceso de admisión y los observables clínicos son considerados como condiciones asistenciales (Menéndez, 1992). La admisión debe ser eficiente para la identificación del mejor abordaje terapéutico y la mejor distribución de recursos disponibles (Corbella S. & Botella L. 2003). La primera entrevista, y las entrevistas diagnósticas han sido estudiadas con el fin de corroborar su utilidad para procurar adhesión al tratamiento, especialmente en procesos terapéuticos con pacientes severos (Acosta, 2003; Yeomans, 2007; Rodríguez et. al 2001) y para corroborar la permanencia a lo largo del tratamiento de las hipótesis y propuestas terapéuticas (Menéndez, Mayorga y Bodon; 2005). Se estudia el impacto de diversas variables en los momentos iniciales del tratamiento por medio de protocolos que acompañan esta presentación. Las variables establecidas son: los datos obtenidos durante el proceso de admisión, los datos clínicos del paciente y la alianza de trabajo establecida con el admisor.

This study is focused on the admission process of 30 consultants. The admission process itself and the clinical observables are considered as assistential conditions (Menéndez, 1992). The admission must be efficient for the identification of better therapeutic approach and to the better distribution of available resources (Corbella S. & Botella L. 2003). The first interview, initial interviews and diagnostic interviews have been studied in order to corroborate their utility to improve of treatment adherence, especially in therapeutic process of severe patients (Acosta, 2003; Yeomans, 2007; Rodríguez et. al 2001) and, to corroborate the permanency along treatment of initial therapeutic hypotheses or proposals (Menéndez, Mayorga y Bodon; 2005). We study the impact of several relevant variables on treatment initial moments by means of protocols that accompany this presentation. The defined variables are: admission data of the process itself, clinical data of patient and working alliance established with admisor.