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Perceptions of the working alliance among medical staff and cancer patients

Published online by Cambridge University Press:  19 June 2015

Gil Bar-Sela ,
Inbal Mitnik  and
Doron Lulav-Grinwald
Gil Bar-Sela*
Affiliation:
Division of Oncology, Rambam Health Care Campus, Haifa, Israel Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
Inbal Mitnik
Affiliation:
Division of Oncology, Rambam Health Care Campus, Haifa, Israel
Doron Lulav-Grinwald
Affiliation:
Division of Oncology, Rambam Health Care Campus, Haifa, Israel
*
Address correspondence and reprint requests to: Gil Bar-Sela, Director, Integrated Oncology and Palliative Care Unit, Rambam Health Care Campus, P.O.B. 9602, Haifa 31096, Israel. E-mail: [email protected]
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Abstract

Objective:

A working alliance (WA) is considered an essential factor in therapeutic relationships, relating to the mutual and interactive aspects of the relationship. In the medical setting, a WA has been found to be related to various positive outcomes; however, it has previously been investigated solely from the patient's perspective. The aim of the current study was to measure the concept from both sides of the patient–medical staff interaction.

Method:

Physicians, nurses, and advanced cancer patients completed the Working Alliance Inventory–Short Revised.

Results:

Some 32 physicians, 39 nurses, and 52 advanced cancer patients completed the study. Senior staff members rated the WA higher than trainees, both among physicians and nurses. Physicians and nurses rated the “bonds” subscale highest, while patients rated “goals” at the highest level. In addition, a significant difference was demonstrated between physicians and patients, with patients rating the WA higher.

Conclusions:

These preliminary findings demonstrate different perspectives among advanced cancer patients and medical staff interactions. Future studies should investigate the interactive aspects of the WA concept in the medical setting.

Significance of results:

Awareness of the working alliance in patient–staff interactions may improve the quality of treatment given to patients confronting cancer.

Keywords

CancerOncologyPatient–medical staff interactionWorking alliance
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 3 , June 2016 , pp. 199 - 203
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

Bachelor, A. & Salame, R. (2000). Participants' perceptions of dimensions of the therapeutic alliance over the course of therapy. The Journal of Psychotherapy Practice and Research, 9, 39–53.Google Scholar
Bethea, A.R., Acosta, M.C. & Haller, D.L. (2008). Patient-versus-therapist alliance: Whose perception matters? Journal of Substance Abuse Treatment, 35, 174–183.CrossRefGoogle ScholarPubMed
Bordin, E. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.Google Scholar
Bowlby, J. (1989). The role of attachment in personality development and psychopathology. In The course of life, Vol. 1: Infancy. Greenspan, S. & Pollock, H. (eds.), pp. 229–270. Madison, WI: International Universities Press.Google Scholar
Burns, J.W. & Evon, D. (2007). Common and specific process factors in cardiac rehabilitation: Independent and interactive effects of the working alliance and self-efficacy. Health Psychology, 26, 684–692.Google Scholar
Busseri, M.A. & Tyler, J.D. (2004). Client–therapist agreement on target problems, working alliance, and counseling outcome. Psychotherapy Research, 14, 77–88.Google Scholar
Cecero, J.J., Fenton, L.R., Nich, C., et al. (2001). Focus on therapeutic alliance: The psychometric properties of six measures across three treatments. Psychotherapy, 38, 1–11.Google Scholar
de Bolle, M., Johnson, J.G. & De Fruyt, F. (2010). Patient and clinician perceptions of therapeutic alliance as predictors of improvement in depression. Psychotherapy and Psychosomatics, 79, 378–385.CrossRefGoogle ScholarPubMed
Dundon, W.D., Pettinati, H.M., Lynch, K.G., et al. (2008). The therapeutic alliance in medical-based interventions impacts outcome in treating alcohol dependence. Drug and Alcohol Dependence, 95, 230–236.Google Scholar
Fitzpatrick, M.R., Iwakabe, S. & Stalikas, A. (2005). Perspective divergence in the working alliance. Psychotherapy Research, 15, 69–79.Google Scholar
Fuertes, J.N., Mislowack, A., Bennett, J., et al. (2007). The physician–patient working alliance. Patient Education and Counseling, 66, 29–36.CrossRefGoogle ScholarPubMed
Fuertes, J.N., Boylan, L.S. & Fontanella, J.A. (2009). Behavioral indices in medical care outcome: The working alliance, adherence, and related factors. Journal of General Internal Medicine, 24, 80–85.CrossRefGoogle ScholarPubMed
Hatcher, R.L. & Gillaspy, J.A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy Research, 16, 12–25.Google Scholar
Hillen, M.A., de Haes, H.C.J.M. & Smets, E.M.A. (2011). Cancer patients' trust in their physician: A review. Psycho-Oncology, 20, 227–241.CrossRefGoogle ScholarPubMed
Hilsenroth, M.J., Peters, E.J. & Ackerman, S.J. (2004). The development of therapeutic alliance during psychological assessment: Patient and therapist perspectives across treatment. Journal of Personality Assessment, 83, 332–344.CrossRefGoogle ScholarPubMed
Horvath, A.O. (1994). Research on the alliance. In The working alliance: Theory, research, and practice. Horvath, A.P. & , L.S. (eds.), pp. 259–286. New York: Wiley.Google Scholar
Horvath, A.O. & Greenberg, L.S. (1989). Development and validation of the working alliance inventory. Journal of Counseling Psychology, 36, 223–233.Google Scholar
Horvath, A.O. & Greenberg, L.S. (eds.) (1994). The working alliance: Theory, research, and practice. New York: Wiley.Google Scholar
Horvath, A.O. & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561–573.Google Scholar
Horvath, A.O. & Symonds, B.D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139–149.Google Scholar
Levinson, W., Lesser, C.S. & Epstein, R.M. (2010). Developing physician communication skills for patient-centered care. Health Affairs, 29, 1310–1318.CrossRefGoogle ScholarPubMed
Mack, J.W., Block, S.D., et al. (2009). Measuring therapeutic alliance between oncologists and patients with advanced cancer: The Human Connection Scale. Cancer, 115, 3302–3311.Google Scholar
Maguire, P. (2002). Improving the recognition of concerns and affective disorders in cancer patients. Annals of Oncology, 13(Suppl. 4), 177–181.CrossRefGoogle ScholarPubMed
Marmarosh, C.L. & Kivlighan, D.M. (2012). Relationships among client and counselor agreement about the working alliance, session evaluations, and change in client symptoms using response surface analysis. Journal of Counseling Psychology, 59, 352–367.Google Scholar
Mead, N. & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine, 51, 1087–1110.Google Scholar
Moreau, D., Goldgran-Toledano, D., Alberti, C., et al. (2004). Junior versus senior physicians for informing families of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 169, 512–517.Google Scholar
Munder, T., Wilmers, F., Leonhart, R., et al. (2010). Working Alliance Inventory–Short Revised (WAI–SR): Psychometric properties in outpatients and inpatients. Clinical Psychology & Psychotherapy, 17, 231–239.Google Scholar
Ogrodniczuk, J.S., Piper, W.E., Joyce, A.S., et al. (2000). Different perspectives of the therapeutic alliance and therapist technique in two forms of dynamically oriented psychotherapy. Canadian Journal of Psychiatry, 45, 452–458.Google Scholar
Pegman, S., Beesley, H., Holcombe, C., et al. (2011). Patients' sense of relationship with breast cancer surgeons: The relative importance of surgeon and patient variability and the influence of patients' attachment style. Patient Education and Counseling, 83, 125–128.CrossRefGoogle ScholarPubMed
Petry, N.M. & Bickel, W.K. (1999). Therapeutic alliance and psychiatric severity as predictors of completion of treatment for opioid dependence. Psychiatric Services, 50, 219–227.Google Scholar
Rotman, I. (1999). Attachment styles in adulthood and the development of the working alliance [in Hebrew]. Masters thesis. Haifa: Department of Psychology, University of Haifa.Google Scholar
Rozmarin, E., Muran, C.J., Safran, J., et al. (2008). Subjective and intersubjective analysis of the therapeutic alliance in a brief relational therapy. American Journal of Psychotherapy, 62, 313–328.Google Scholar
Tracey, T.J. & Kokotovic, A.M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207–210.CrossRefGoogle Scholar
Trevino, K.M., Fasciano, K. & Prigerson, H.G. (2013). Patient–oncologist alliance, psychosocial well-being, and treatment adherence among young adults with advanced cancer. Journal of Clinical Oncology, 31, 1683–1689.Google Scholar
Tryon, G.S., Blackwell, S.C. & Hammel, E.F. (2007). A meta-analytic examination of client–therapist perspectives of the working alliance. Psychotherapy Research, 17, 629–642.Google Scholar
Van Walsum, K.L., Lawson, D.M. & Bramson, R. (2004). Physicians' intergenerational family relationships and patients' perceptions of working alliance. Families, Systems, & Health, 22, 457–473.CrossRefGoogle Scholar