DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

It appears that what links the conceptualisations and hence the measurements (discussed
below) are attachment between the therapist and patient and their collaboration or
“willingness to invest in the therapy process” (Horvath and Luborsky, 1993). It appears
that in the complex interchange involved in any therapy interaction many factors may
play a role in the establishment of a positive therapeutic relationship. It therefore seems
likely that reducing this to a single factor such as empathy, or oversimplifying the
diversity of factors and their interaction, will not do the area justice. Many theorists also
conclude that the therapy relationship is important in its own right (e.g. Freud, 1912,
Rogers, 1957).
Measurements of Therapeutic Alliance
Researchers have attempted to create scales that measure the concept of the alliance
based on the various understandings considered above and it is currently estimated that
there are at least 11 alliance assessment methods. These include the Pennsylvania scales
(HAr, HAcs, HAq) from Luborsky et al (1983); the Vanderbilt Therapeutic Alliance
Scale (VPPS/VTAS) by Strupp and colleagues; The Toronto Scales (TARS) created by
Marziali and her colleagues, which combines items generated from the two scales above;
and the Working Alliance Inventory (WAI), (Horvath 1981, 1982). Additionally, there
are the California Scales (CALPAS/ CALTARS) based on Marziali & Marmars TAR and
the Therapeutic Bond Scales (TBS) by Saunders, Howard, Orlinsky (1989). These scales
are considered to have acceptable psychometric properties and are reliable, with the
therapist based measures the most stable (Horvath and Symonds 1991).
The variance between these scales can be explained by the fact that the different
measurement instruments were devised from different conceptualisations of the construct.
The Penn scales were created to test Luborsky’s (1984) psychodynamic concept of the
helping alliance measuring Type 1 and Type 2 as described above. The Vanderbilt scales
and the Toronto scales combined dynamic and integrative conceptualisations of the
alliance. The working alliance inventory was based on Bordins’ three concepts and
wanted to connect the alliance measure to a general theory of therapeutic change. The
VPPS, VTAS and TARS attempt to measure more eclectic blends of the alliance
construct than the others.
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