The 4-Point ordinal Alliance Self-report: a self-report questionnaire for assessing therapeutic relationships in routine mental health.
Comprehensive Psychiatry. 2009-03-01; 50(2): 181-185
DOI: 10.1016/j.comppsych.2008.06.010
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1. Compr Psychiatry. 2009 Mar-Apr;50(2):181-5. doi:
10.1016/j.comppsych.2008.06.010. Epub 2008 Aug 23.
The 4-Point ordinal Alliance Self-report: a self-report questionnaire for
assessing therapeutic relationships in routine mental health.
Misdrahi D(1), Verdoux H, Lançon C, Bayle F.
Author information:
(1)Département de Psychiatrie Adulte, Centre Hospitalier Charles Perrens,
Bordeaux, France.
BACKGROUND: The quality of the relationship between patient and therapist can be
considered a cornerstone of psychiatric practice. Nonadherence is one of the
leading problems affecting antipsychotic effectiveness in schizophrenic patients
and represents a poor prognostic factor for schizophrenia. Among the factors
influencing adherence, the clinician’s style of communication and the
therapeutic relationship (TR) are recognized as key points. The measures of TR
have been broadly explored in psychotherapy process but have received little
attention in the treatment of severe mental illness in the context of routine
mental health. Our objective was to build a self-rating scale easy to use in
clinical psychiatric practice to assess TR, including drug-taking aspects and
the relationship with the clinician on a day-to-day basis. A secondary objective
was to assess the scale’s validity and the association between TR and adherence.
METHODS: The study was conducted with 92 consenting inpatients who met specified
criteria for schizophrenia and schizoaffective disorders (Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition). Assessments of TR were
obtained by the 4-Point ordinal Alliance Self-report and an 8-cm visual analog
scale completed by the patient 1 week before discharge, after the remission of
acute symptomatology. Adherence behavior was estimated with a new valid and
reliable questionnaire called the Medication Adherence Rating Scale. Factor
analysis was performed.
RESULTS: Internal consistency was assessed by calculating Cronbach alpha, which
revealed a highly satisfactory value (alpha = .91). After oblique rotation was
run, 2 understandable factors were extracted that we termed empathy experienced
and psychoeducation.
CONCLUSIONS: Therapeutic relationship with the clinician can be considered a
prerequisite for positive treatment course and outcome. The detection of
subpopulations characterized by determinants of poor TR could be the first step
toward improving schizophrenia prognosis linked to poor adherence.
DOI: 10.1016/j.comppsych.2008.06.010
PMID: 19216896 [Indexed for MEDLINE]