Patients' view of the alliance of psychotherapy: exploratory factor analysis of three alliance measures.

Extending a previous study (R.L. Hatcher, A. Barends, J. Hansell, & M.J. Gutfreund, 1995), factor analysis of 3 alliance measures completed by 231 patients explored patients' views of the alliance. Two of 6 factors, Confident Collaboration and Idealized Relationship (with the substantial general factor removed), correlated with patients' estimate of improvement (rs = .37 and -.23, respectively; p < .001). Patients view the core of the alliance as a purposive mutual collaboration, or working alliance; patients who acknowledge some hostility do better in therapy. Three other factors--Goals and Tasks, Bond, and Dedicated Patient--resemble established subscales but are unrelated to improvement beyond the general factor. Factor 6 assesses improvement rather than alliance. The collaborative working alliance should be given prominence in alliance theory and measurement.

Patients' and therapists' shared and unique views of the therapeutic alliance: an investigation using confirmatory factor analysis in a nested design.

The characteristically large general factor found in measures of the therapeutic alliance was analyzed by use of confirmatory factor analysis (CFA) in a nested design. Ratings by 38 therapists and their 144 patients on the California Psychotherapy Alliance Scales (CALPAS), the Revised Penn Helping Alliance Questionnaire (HAQ-R), and the Working Alliance Inventory (WAI) were adjusted for therapist effects. A set of models for patient and therapist ratings was tested with CFA, and a 3-factor model was confirmed, chi 2(4) = 7.19, p > .13; GFI = .98; RMSR = .02; CFI = 1.0. A shared-view factor (best represented by HAQ-R) accounted for 44% of patients' and 27% of therapists' variance. Unique factors (best represented by WAI) accounted for 56% of therapists' and 43% of patients' variance. Patient views split between HAQ (helpfulness) and WAI (goals, tasks) factors; The WAI factor was most expressive of therapist views. Patients and therapists tended to agree on helpfulness and on therapist clarity about goals and tasks. A multimeasure approach to alliance assessment is recommended.