Two helping alliance methods for predicting outcomes of psychotherapy. A counting signs vs. a global rating method

This paper reports on the development of measures of helping alliances in psychotherapy, i.e., the patient's experience of the treatment or relationship with the therapist as helpful, or potentially helpful. The helping alliance counting signs measure, which is the special focus of this paper, entails the counting of certain types of patient statements (signs) which are identified in a manual. The main findings were: a) these types of statements were found to be "scorable" with moderate interjudge agreement; b) scores based on the manual showed moderate agreement with a similar helping alliance manual based upon global ratings; c) scores were fairly to moderately consistent from early to late in treatment; d) scores predicted outcome significantly, e.g., early positive signs of helping alliance correlated .57 (p less than .01) with rated benefits, and .59 (p less than .01) with change in the first target complaint (Battle, C., Imber, S., Hoehn-Saric, R., et al. Target complaints as criteria of improvement. Am. J. Psychother., 20: 184-192, 1966); and e) basic background similarities between patient and therapist, such as in age and religious activity, attained highest correlations with the helping alliance measure, e.g., the sum of 10 similarities correlated .60 (p less than .01) with early positive helping alliance counting signs.