Rehabilitation Measures Database
  1. Rehabilitation Measures Database
  2. Working Alliance Inventory

Working Alliance Inventory

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Purpose

The WAI evaluates the collaborative relationship between the helper and the client, but does not encompass all aspects of the therapy relationship (i.e. clinical outcomes, recidivism).

Link to Instrument

Instrument Details

Acronym WAI

Area of Assessment

Patient Satisfaction

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$0.00

Cost Description

The survey and associated scoring are available on the internet. Translated versions are available as well. Horvath released the rights and any assessment requests should be made to the Society for Psychotherapy Research (SPR).

Populations

Non-Specific Patient Population
Mixed Populations
Mental Health

Key Descriptions

  • ● Number of items in the instrument
    ○ 36 questions (12 question short form)
    ○ 3 domains: Task, Goal, and Bond
    ▪ 12 questions for each domain
  • ● Minimum and maximum scores
    ○ Each item is scored from 1-7, minimum=1 to maximum=7
    ○ Minimum total score 36 to Maximum total score of 252
  • ● Brief description of item scoring
    ○ Higher scores reflect a more positive rating of working alliance
    ○ Rate a provided statement on a scale of 1-7
    ▪ 1 - Never
    ▪ 2 - Rarely
    ▪ 3 - Occasionally
    ▪ 4 - Sometimes
    ▪ 5 - Often
    ▪ 6 - Very Often
    ▪ 7 - Always

Number of Items

36 (12 on the short form)

Equipment Required

  • WAI Form

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

+

years

Instrument Reviewers

Aimee Dietsch, MA

Dawn Osborne, PT, DPT

ICF Domain

Activity
Participation

Measurement Domain

Emotion

Considerations

Scale with potential to be used in any helper/helpee relationship.  There are no standardized measurements for the WAI because the tool measures opinion and self-perception of the relationship.

Mixed Populations

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Standard Error of Measurement (SEM)

Online Therapy (Cook & Doyle, 2002; n=15; mean age=41.4(15.9) years)

  • SEM manually calculated using SEM=SD/(√n)
    • Email group & Chat group
  • SEM for Email group (n=12),
    • WAI-client composite = 4.18
    • WAI-client Goal subscale = 1.70
    • WAI-client Bond subscale = 1.88
    • WAI-client Task subscale = 1.43
  • SEM for Chat group (n=3)
    • WAI-client composite = 12.13
    • WAI-client Goal subscale = 3.71
    • WAI-client Bond subscale = 2.60
    • WAI-client Task subscale = 4.26

 

Sex Offenders (DeSorcy, Olver, Wormith, 2017; n=111; mean age = 37 (10.5)

  • SEM manually calculated using SEM=SD/(√n)
  • SEM for group WAI-client composite group (n = 111) = 3.26

Minimal Detectable Change (MDC)

Online Therapy (Cook & Doyle, 2002)

  • MDC manually calculated using MDC=1.96 x SEM x √2
    • Email group & Chat group
  • MDC for Email group (n=12),
    • WAI-client composite = 4.18
    • WAI-client Goal subscale = 4.71
    • WAI-client Bond subscale = 5.21
    • WAI-client Task subscale = 3.96
  • MDC for Chat group (n=3),
    • WAI-client composite = 33.62
    • WAI-client Goal subscale = 10.28
    • WAI-client Bond subscale = 7.21
    • WAI-client Task subscale = 11.81

 

Sex Offenders (DeSorcy, Olver, Wormith, 2017)

  • MCD manually calculated using MDC=1.96 x SEM x √2
  • MDC for WAI-client composite (n = 111) = 9.04
  • CI = 95%

Normative Data

Online Therapy (Cook & Doyle, 2002)

WORKING ALLIANCE MEANS AND STANDARD DEVIATIONS BASED ON MODALITY OF INTERVENTION

 

Primary Modality

Secondary Modality

 

Email (n=12)

Chat (n=3)

None (n=10)

 

Other (n=5)

 

WAI Scale

Mean

SD

Mean

SD

Mean

SD

Mean

SD

Task

69.75

4.94

72.67

7.37

68.80

4.59

73.40

5.86

Bond

70.92

6.52

78.67

4.51

70.50

7.11

76.40

4.51

Goal

71.00

5.89

77.33

6.43

70.70

6.44

75.40

6.15

Composite

211.67

14.47

228.67

17.50

210.00

14.82

225.20

14.70

 

Sex Offenders (DeSorcy, Olver, Wormith, 2017; n=111; mean age = 37 (10.5)

WAI Measure

Mean

Standard Deviation

Task

68.09

10.69

Bond

61.55

13.86

Goal

65.18

12.59

Total

194.82

34.38

Internal Consistency

Counseling (Horvath, 1981; n=29, mean age=34.6 (SD=unknown)

  • Excellent:  WAI-client composite - Cronbach alpha = 0.93
  • Excellent:  WAI-therapist composite - Cronbach alpha = 0.87

Online Therapy (Cook & Doyle, 2002)

  • Excellent: WAI-client composite – Cronbach’s alpha=0.86
  • Poor:  WAI-client Task subscale – Cronbach’s alpha = 0.59
  • Adequate: WAI-client Bond subscale – Cronbach’s alpha = 0.70
  • Adequate:  WAI-client Goal subscale – Cronbach’s alpha = 0.76

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Sex Offenders (DeSorcy, Olver, Wormith, 2017)

  • Poor: When considering the long term outcomes and impact of a working therapeutic alliance, the WAI demonstrated no impact as shown by recidivismp=.368 (no statistical significance between WAI in predicting general recidivism).

Construct Validity

Convergent Validity:

Counseling, Clinical Study (Horvath, 1981)

  • Excellent:  Correlation between Goal-therapist subscale and Task-client subscales was only .01 less than the corresponding validity coefficient (r = .76)

Responsiveness

Online Therapy (Cook & Doyle, 2002)

  • Subscale (task, bond, goal) & composite scores all higher for online therapy compared to face-to-face therapy clients
    • only Goal and Composite were statistically significant
  • WAI-client composite score with online therapy p<0.05
    • t-test = 2.307; p=0.037
  • WAI-client goal subscale score with online therapy p<0.01   
    • t-test = 3.039; p= 0.009

 

Sex Offenders (DeSorcy, Olver, Wormith, 2017)

  • Sample was divided based on PCL-R (Psychopathy Checklist-revised) ratings of <25 or 25+ creating two groups.
  • Cohen’s d showed generally small in magnitude differences between high and low psychopathy groups on WAI score, with the highest (albeit non-significant) difference found on the Bond scale (d = .19), or about one fifth of a standard deviation

Mental Health

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Standard Error of Measurement (SEM)

Individuals with Schizophrenia and Schizoaffective Disorder (Gehrs & Goering, 1994; Clients n=22; mean age = 34.3(SD-unknown); Therapists n=12; mean age = 36.7(SD=unknown); mean years working with population = 6.1

  • SEM manually calculated using SEM=SD/(√n)
  • SEM WAI-therapist composite, assessment time 1 (n=22) =5.05
  • SEM WAI-therapist composite, assessment time 2 (n=21) = 5.06
  • SEM WAI-client composite, assessment time 1 (n=22) = 6.14
  • SEM WAI-client composite, assessment time 2 (n=20) = 6.14

Minimal Detectable Change (MDC)

Individuals with Schizophrenia and Schizoaffective Disorder (Gehrs & Goering, 1994)

  • MDC manually calculated using MDC=1.96 x SEM x √2
  • MDC WAI-therapist composite, assessment time 1 (n=22) = 14.00
  • MDC WAI-therapist composite, assessment time 2 (n=21) = 14.03
  • MDC WAI-client composite, assessment time 1 (n=22) = 17.01
  • MDC WAI-client composite, assessment time 2 (n=20) = 15.62

Normative Data

Individuals with Schizophrenia and Schizoaffective Disorder (Gehrs & Goering, 1994)

 

WAI Scores

 

N

Min-Max

Mean

Median

SD

Rehabilitation therapist:

 

 

 

 

 

     Time 1

22

113.0-211.0  

173.6   

174.0    

23.7

     Time 2

21

139.0-241.0  

190.7   

185.0    

23.2

Client

 

 

 

 

 

     Time 1

22

113.0-227.0  

185.4   

188.8    

28.8

     Time 2

20

133.0-219.0  

180.6   

184.0    

25.2

Construct Validity

Construct Validity:

Individuals with Schizophrenia and Schizoaffective Disorder (Gehrs & Goering, 1994)

  • Excellent:  Construct validity between therapist and client scores on the WAI (r=.72 at time 1 and r=.69 at time 2)
  • Adequate-Excellent:  Construct validity between therapist scores on the WAI and Modified Goal Attainment Scale (r=.48 at time 1 and r=.67 at time 2)
  • Adequate:  Construct validity between client scores on the WAI and Modified Goal Attainment Scale (r= .49 at time 2)

Responsiveness

Alcoholism (Connors, DiClemente, Dermen, Kadden, Carroll, Frone, 2000)

  • Outpatient and Aftercare samples
  • Statistically significant relationship (p<0.001, p<0.01, p<0.05) in select categories
    • outpatient sample and WAI-client scores
    • outpatient sample and WAI-therapist scores
    • aftercare sample and WAI-client scores
    • aftercare sample and WAI-therapist scores in select categories
    • Most significant was readiness to change and WAI

 

Alcoholism (Connors, Carroll, DiClemente, Longabaugh, 1997; Outpatient group n=698, outpatient mean age=39.3(10.8), outpatient mean alcohol dependence symptoms=5.7(1.9); Aftercare group n=498, aftercare mean age=42.6(11.0); aftercare mean alcohol dependence symptoms=6.8(1.9)

  • Consistent prediction among outpatient alcoholic clients of treatment participation and positive drinking related outcomes whether from client or therapist perspective
  • WAI positively related to treatment participation & % of days abstinent; negatively related to drinks per drinking day
    • WAI-client: change in R2ranged from .008-.015
    • WAI-therapist: change in R2 ranged from .013-.034
  • WAI-therapist positive predictors of % of days abstinent

Bibliography

Connors, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R. Donovan, D. M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65(4), 588-598.

 

Connors, G. J., DiClemente, C. C., Dermen, K. H., Kadden, R., Carroll, K. M., & Frone, M. R. (2000). Predicting the therapeutic alliance in alcoholism treatment. Journal of Studies on Alcohol, 61, 139-149.

 

Cook, J. E. & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. Cyber Psychology & Behavior, 5(2), 95-105.

 

Desorcy, D. R., Olver, M. E., & Wormith, J. S. (2017). Working alliance and psychopathy: Linkages to treatment outcome in a sample of treated sexual offenders. Journal of Interpersonal Violence, 1–22. doi: 10.1177/0886260517698822

 

Gehrs, M., & Goering, P. (1994). The relationship between the working alliance and rehabilitation outcomes of schizophrenia. Psychosocial Rehabilitation Journal, 18(2), 43–54. doi: 10.1037/h0095517

Horvath, A. (1981). An exploratory study of the working alliance:  Its measurement and relationship to therapy outcome. Unpublished doctoral thesis. University of British Columbia. Retrieved from https://open.library.ubc.ca/cIRcle/collections/ubctheses/831/items/1.0054327

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