Exploring therapeutic alliance in brief inpatient psychotherapy: a preliminary study

Therapeutic alliance is one of the most widely investigated variables in psychotherapy research but few studies have explored its role in inpatient psychotherapy. Many factors likely contribute to the lack of inpatient alliance research including the short length of hospital stays, complexity of patient psychopathology and the burdensome quality of most alliance scales. This paper reports on the development and initial application of two comparable brief scales designed to capture patient and therapist alliance ratings.

Participants were 20 patients receiving supportive-expressive inpatient psychotherapy. The patients were predominantly depressed women. Baseline measures of distress, symptom severity and functioning were obtained at the first and third sessions. Measures of alliance were obtained at the second session.

The brief alliance scales demonstrated adequate internal consistency and the individual items had good adjusted item-to-scale correlations. Consistent with the broad alliance literature, we found that patients rated alliance higher than therapists, patient and therapist alliance ratings were not significantly correlated, and level of functioning was significantly associated with both patients and therapists' alliance ratings. The perceived depth of psychotherapy was also significantly associated with alliance. Unexpectedly, alliance ratings were also negatively associated with improvement during hospitalization.

Overall, the study demonstrates both the feasibility and potential benefit of conducting inpatient psychotherapy research.