Association between interpersonal behaviour and helping alliance in substance-dependent patients

The German version of the helping alliance questionnaire: psychometric properties in patients with persistent depressive disorder

BACKGROUND

The Helping Alliance Questionnaire (HAQ) is a frequently used and highly relevant instrument to assess the therapeutic alliance. The questionnaire was translated into German by Bassler and colleagues (1995) and is available for patients (HAQ-P) and therapists (HAQ-T). Whereas the HAQ-P has been tested regarding psychometrics, the HAQ-T has not. This study aimed at further investigating the psychometric properties of both the HAQ-P and HAQ-T. We hypothesized that the instrument is reliable and shows factorial as well as convergent validity.

METHODS

Within the framework of a multisite, randomized-controlled clinical trial, comparing the efficacy of Cognitive Behavioral Analyses System of Psychotherapy (CBASP) and supportive psychotherapy (SP) in the treatment of early onset persistently depressed outpatients, the HAQ was filled out by patients (n = 255) and therapists (n = 81). 66.0% of patients were female; average age at randomization was 44.9 years (SD = 11.8). Several confirmatory factor analyses were conducted to test different structures for the HAQ. In addition, correlations between the HAQ and the Inventory of Interpersonal Problems (IIP) were calculated to test for convergent validity.

RESULTS

Goodness of fit indices for both a model with two different but strongly related factors named 'relation to the patient/ therapist ' and 'satisfaction with therapeutic outcome' and a second model with only one global helping alliance factor were comparable: Chi-Square-based indices rejected the models; RMSEA closely approached the threshold of good model fit, and CFI/ TLI and SRMR suggested that both models sufficiently fit the data. The internal consistency (Cronbach's α) calculated for the different scales of the HAQ ranges between questionable to good. Finally, the HAQ scores were significantly related to some of the IIP scores.

CONCLUSIONS

The German versions of the HAQ offer sufficient reliable instruments for the quick assessment of different facets of the therapeutic alliance. The HAQ global scores can be used as indicators for the global impression of the patients and therapists perception of the quality of the therapeutic alliance. However, the small correlations found between the IIP and the HAQ puts the question of external validity into perspective.

TRIAL REGISTRATION

This study analysed data from a RCT which was registered on ClinicalTrials.com ( NCT00970437 ). First submitted on September 1, 2009.

The alliance in psychiatric rehabilitation: Client characteristics associated with the initial alliance in a supported employment program

BACKGROUND

The therapeutic alliance is associated with outcomes for individuals in psychiatric rehabilitation programs. However, there are no known studies examining factors associated with the alliance in these programs.

OBJECTIVE

To determine whether client characteristics associated with the alliance across multiple populations and program types were associated with the alliance for individuals enrolling in a supported employment program.

METHODS

Previously collected data were available for 70 individuals served by the single employment specialist in the program. Potential independent variables and the strength of their relationship to the alliance were identified, then further explored using a forward stepwise logistic regression model.

RESULTS

Seventy-three percent of the sample had the highest possible alliance rating. Being older and having a smaller social network size were significantly correlated with a high alliance, but neither remained a predictor of the alliance, controlling for the effects of the other.

CONCLUSIONS

Client age and social network size were associated with the initial alliance, though not in a model containing both variables. Low power may have hindered the ability to show additional relationships, and the uniqueness of the program structure limits the generalizability to other programs. Future research should investigate the variables examined further.

Predictors of Outcome among Pathological Gamblers Receiving Cognitive Behavioral Group Therapy

AIMS

The aim of this study was to evaluate posttreatment changes of individuals with a diagnosis of gambling disorder (GD) treated with group cognitive behavioral therapy (CBT), to assess the potential moderator effect of sex on CBT outcome, and to explore the best predictors of posttreatment changes, relapse, and dropout rates.

METHODS

A cohort design was applied with a prospective follow-up. The sample comprised 440 patients and the CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period.

RESULTS

Patients showed significant improvements in both the level of psychopathology and the severity of the gambling behavior. High self-transcendence and the involvement of the spouse or partner in the therapy predicted a higher risk of relapse. Younger age and low education predicted a higher risk of dropout.

CONCLUSION

Many patients with GD can be treated with strategies to improve self-control and emotional regulation, but other techniques should be incorporated to address the individual characteristics of each patient. This is particularly important in group therapy, in which the same treatment is applied to several patients simultaneously. The involvement of a family member needs to be carefully considered since it may have a negative effect on the response to treatment if not adequately managed.