Examining and Measuring the Therapeutic Alliance in a Neuropsychological Assessment Setting: A Preliminary Study

• Published in: Professional psychology, research and practice research and practice, 2024-06, Vol.55 (3), p.238-244
• Main Authors: Schaffer, Jamie B., Walsh, Lucy, Eubanks, Catherine F.
• Format: Article
• Language: English
• Subjects: Clinical Practice; Clinical Psychologists; Examiners; Familiarity; Female; Human; Impact analysis; Male; Neuropsychological Assessment; Neuropsychology; Psychological assessment; Psychotherapeutic Processes; Self report; Supervisors; Therapeutic Alliance; Therapeutic alliances; Time use
• ISSN: 0735-7028; 1939-1323
• DOI: 10.1037/pro0000562

Though the impact of the therapeutic alliance on therapy outcomes has been well-demonstrated, little research exists regarding the therapeutic alliance within a neuropsychological assessment setting. This brief report, therefore, explores the relevance and application of the concept of the therapeutic alliance within an assessment context. A self-report measure of clinician alliance ratings (Working Alliance Inventory-Neuropsychology [WAI-NP]) was adapted for use in an assessment setting and completed by 141 examiner participants in relation to the most recent patient they saw in an assessment. This study was the first to adapt an alliance measure for an assessment context and to consider the impact of the alliance on factors directly related to the assessment. However, internal consistency of the WAI-NP was α = .63, indicating the need for future research to clarify how to best capture the alliance in assessments. Additionally, though there was no significant relationship between time spent in assessment activities and the alliance, other variables emerged as significant predictors of the alliance, including how familiar examiners were with the concept of the alliance, which was also correlated with time spent in assessment. Though more research is needed to clarify relevant outcomes to measure to quantify the alliance's impact on assessments, initial findings suggest that examiner familiarity with the alliance may impact assessments and that there may be points of intervention to enhance the alliance, and in turn, improve neuropsychological assessments. Implications for researchers, practicing neuropsychologists, and supervisors are discussed. Public Significance Statement This study is a first step in measuring and evaluating the therapeutic alliance in an assessment setting. Findings suggest that clinicians familiar with the alliance may experience stronger alliances with patients during neuropsychological assessments and point to the need for more research in this area.