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BMC Psychiatry
Published in: BMC Psychiatry 1/2018

Open Access 01-12-2018 | Research article

The German version of the helping alliance questionnaire: psychometric properties in patients with persistent depressive disorder

Authors: Hannah Sophie Eich, Levente Kriston, Elisabeth Schramm, Josef Bailer

Published in: BMC Psychiatry | Issue 1/2018

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Abstract

Background

The Helping Alliance Questionnaire (HAQ) is a frequently used and highly relevant instrument to assess the therapeutic alliance. The questionnaire was translated into German by Bassler and colleagues (1995) and is available for patients (HAQ-P) and therapists (HAQ-T). Whereas the HAQ-P has been tested regarding psychometrics, the HAQ-T has not. This study aimed at further investigating the psychometric properties of both the HAQ-P and HAQ-T. We hypothesized that the instrument is reliable and shows factorial as well as convergent validity.

Methods

Within the framework of a multisite, randomized-controlled clinical trial, comparing the efficacy of Cognitive Behavioral Analyses System of Psychotherapy (CBASP) and supportive psychotherapy (SP) in the treatment of early onset persistently depressed outpatients, the HAQ was filled out by patients (n = 255) and therapists (n = 81). 66.0% of patients were female; average age at randomization was 44.9 years (SD = 11.8). Several confirmatory factor analyses were conducted to test different structures for the HAQ. In addition, correlations between the HAQ and the Inventory of Interpersonal Problems (IIP) were calculated to test for convergent validity.

Results

Goodness of fit indices for both a model with two different but strongly related factors named ‘relation to the patient/ therapist ’ and ‘satisfaction with therapeutic outcome’ and a second model with only one global helping alliance factor were comparable: Chi-Square-based indices rejected the models; RMSEA closely approached the threshold of good model fit, and CFI/ TLI and SRMR suggested that both models sufficiently fit the data. The internal consistency (Cronbach’s α) calculated for the different scales of the HAQ ranges between questionable to good. Finally, the HAQ scores were significantly related to some of the IIP scores.

Conclusions

The German versions of the HAQ offer sufficient reliable instruments for the quick assessment of different facets of the therapeutic alliance. The HAQ global scores can be used as indicators for the global impression of the patients and therapists perception of the quality of the therapeutic alliance. However, the small correlations found between the IIP and the HAQ puts the question of external validity into perspective.

Trial registration

This study analysed data from a RCT which was registered on ClinicalTrials.com (NCT00970437). First submitted on September 1, 2009.
Literature
1.
Wampold BE, Imel ZE. The great psychotherapy debate: the evidence for what makes psychotherapy work: Routledge; 2015.
2.
Crits-Christoph P, Gibbons MBC, Mukherjee D. Psychotherapy process-outcome research. In: Oxford LMJ, editor. Bergin and Garfield’s handbook of psychotherapy and behavior change. 6 edition. England: John Wiley & Sons; 2013. p. 298–340.
3.
Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychother Theor Res Prac. 1979;16:252–60.CrossRef
4.
Hatcher RL, Barends AW. How a return to theory could help alliance research. Psychother Theor Res Prac. 2006;43:292–9.CrossRef
5.
Flückiger C, Horvath AO, Del Re AC, Symonds D, Holzer C. Bedeutung der Arbeitsallianz in der Psychotherapie. Psychotherapeut. 2015;60:187–92.CrossRef
6.
Luborsky L. A pattern-setting therapeutic alliance study revisited. Abingdon: Taylor & Francis Group. 2000;
7.
Horvath AO, Greenberg LS. Development and validation of the working alliance inventory. J Couns Psychol. 1989;36:223–33.CrossRef
8.
Marmar CR, Weiss DS, Gaston L. Toward the validation of the California therapeutic alliance rating system. Psychol Assess. 1989;1:46–52.CrossRef
9.
Hatcher RL, Barends AW. Patients' view of the alliance in psychotherapy: exploratory factor analysis of three alliance measures. J Consult Clin Psychol. 1996;64:1326–36.CrossRefPubMed
10.
Gaston L. Reliability and criterion-related validity of the California psychotherapy alliance scales—patient version. Psychol Assess. 1991;3:68–74.CrossRef
11.
Alexander LB, Luborsky L: The Penn Helping Alliance Scales. In The psychotherapeutic process: A research handbook. Edited by Greenberg LS, Pinsof WM. New York, NY: Guilford Press; 1986: 325–366: Guilford clinical psychology and psychotherapy series.].
12.
Luborsky L, McLellan A, Woody GE, O'Brien CP, Auerbach A. Therapist success and its determinants. Arch Gen Psychiat. 1985;42:602–11.CrossRefPubMed
13.
Luborsky L, Barber JP, Siqueland L, Johnson S, Najavits LM, Frank A, Daley D. The revised helping alliance questionnaire (HAq-II) : psychometric properties. J Psychother Pract Res. 1996;5:260–71.PubMedPubMedCentral
14.
Nübling R, Kraft M, Henn J, Kriz D, Lutz W, Schmidt J, Wittmann W, Bassler M. Testing the psychometric properties of the helping alliance questionnaire (HAQ) in different health care settings. Psychother Psychosom Med Psychol. 2017;
15.
Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000;68:438–50.CrossRefPubMed
16.
Elvins R, Green J. The conceptualization and measurement of therapeutic alliance: an empirical review. Clin Psychol Rev. 2008;28:1167–87.CrossRefPubMed
17.
Bassler M, Nübling R. Helping Alliance Questionnaire. In: Diagnostische Verfahren in der Psychotherapie [Diagnostic methods in psychotherapy]. Edited by Brähler E, Schuhmacher J, Srauß B. Göttingen: Hogrefe; 2015. p. 246–9.
18.
Bassler M, Potratz B, Krauthauser H. Der "helping alliance questionnaire" (HAQ) von Luborsky. Psychotherapeut. 1995;40:23–32.
19.
De Weert-Van Oene GH, Jorg F, de Jong CA. Association between interpersonal behaviour and helping alliance in substance-dependent patients. Eur Addict Res. 2006;12:67–73.CrossRefPubMed
20.
Hendriksen M, Van R, Peen J, Oudejans S, Schoevers R, Dekker J. Psychometric properties of the helping alliance questionnaire-I in psychodynamic psychotherapy for major depression. Psychother Res. 2010;20:589–98.CrossRefPubMed
21.
Puschner B, Bauer S, Horowitz LM, Kordy H. The relationship between interpersonal problems and the helping alliance. J Clin Psychol. 2005;61:415–29.CrossRefPubMed
22.
Muran JC, Segal ZV, Samstag LW, Crawford CE. Patient pretreatment interpersonal problems and therapeutic alliance in short-term cognitive therapy. J Consult Clin Psychol. 1994;62:185–90.CrossRefPubMed
23.
McCullough JP. Treatment for chronic depression : cognitive behavioral analysis system of psychotherapy (CBASP). New York: Guilford; 2000.
24.
Schramm E, Kriston L, Zobel I, et al. Effect of disorder-specific vs nonspecific psychotherapy for chronic depression: a randomized clinical trial. JAMA Psychiatry. 2017:E1–E10.
25.
26.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed., text rev. edn. Washington, DC: American Psychiatric Association; 2000.
27.
Hamilton M. Development of a rating scale for primary depressive illness. British journal of social and clinical psychology. 1967;6:278–96.CrossRefPubMed
28.
Markowitz JC, Manber R, Rosen P. Therapists' responses to training in brief supportive psychotherapy. Am J Psychother. 2008;62:67–81.PubMed
29.
Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Stokes J, Han-delsman L, Medrano M, Desmond D, Zule W. Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse Negl. 2003;27:169–90.CrossRefPubMed
30.
First M, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS. Structured clinical interview for DSM-IV Axis II personality disorders (SCID-II). Washington, DC: American Psychiatric Press; 1997.
31.
First M, Spitzer RL, Gibbon M, Williams JBW: Structured clinical interview for DSM-IV-TR Axis I disorders, research version, clinical trials version (SCID-CT). New York, NY: Biometrics Research, New York State Psychiatric Institute; 2002.
32.
Horowitz LM, Alden LE, Kordy H, Strauß B. Inventar zur Erfassung interpersonaler Probleme: deutsche Version; IIP-D. Beltz. TEST. 2000;
33.
Chen F, Curran PJ, Bollen KA, Kirby J, Paxton P. An empirical evaluation of the use of fixed cutoff points in RMSEA test statistic in structural equation models. Sociol Methods Res. 2008;36:462–94.CrossRefPubMedPubMedCentral
34.
SPSS Inc: IBM SPSS statistics for windows. 24 edition. Armonk, NY: IBM Corporation; 2015.
35.
Rosseel Y: lavaan: An R Package for Structural Equation Modeling. In J Stat Softw, vol. 48. pp. 1–36; 2012:1–36.
36.
Li C-H. Confirmatory factor analysis with ordinal data: comparing robust maximum likelihood and diagonally weighted least squares. Behav Res Methods. 2016;48:936–49.CrossRefPubMed
37.
Muncer S, Campbell A: Confirmatory factor analysis and the factor structure of expagg in context: A reply to forrest et al., 2002. Aggress Behav 2004, 30:12 S.
38.
Fan X, Thompson B, Wang L. Effects of sample size, estimation methods, and model specification on structural equation modeling fit indexes. Struct Equ Modeling. 1999;6:56–83.CrossRef
39.
Marsh HW, Balla JR, McDonald RP. Goodness-of-fit indexes in confirmatory factor analysis : the effect of sample size. Psychol Bull. 1988;103:391–410.CrossRef
40.
Beauducel A, Herzberg PY. On the performance of maximum likelihood versus means and variance adjusted weighted least squares estimation in CFA. Struct Equ Modeling. 2006;13:186–203.CrossRef
41.
Constantino M, Smith-Hansen L. Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa. Psychother Res. 2008;18:683–98.CrossRefPubMed
42.
Connolly Gibbons MB, Crits-Christoph P, de la Cruz C, Barber JP, Siqueland L, Gladis M. Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive psychotherapy and cognitive therapy. Psychother Res. 2003;13:59–76.CrossRefPubMed
43.
Taylor R. Interpretation of the correlation coefficient: a basic review. J Diagn Med Sonogr. 1990;6:35–9.CrossRef
Metadata
Title
The German version of the helping alliance questionnaire: psychometric properties in patients with persistent depressive disorder
Authors
Hannah Sophie Eich
Levente Kriston
Elisabeth Schramm
Josef Bailer
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-018-1697-8

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