The Working Alliance Inventory - short revised Psychometric properties of the youth and therapist form in youth mental health and addiction care

The therapeutic alliance is considered to play an important role in youth treatment. The commonly used versions of the Working Alliance Inventory (WAI) are based on Bordin’s three-dimensional alliance model. However, previous psychometric studies of the WAI did not find this three-dimensional structure in youth psychotherapy. These earlier findings may indicate different perceptions of the alliance by adolescent versus adult patients, but may also be due to methodological shortcomings. The current study aims to address previous study limitations by evaluating the factor structure of the most recent and refined version of the WAI in youth treatment and using multilevel analysis to address the hierarchical structure of the alliance data. We examined the psychometric properties of the youth (n = 203) and therapist (n = 62) versions of the short revised WAI in youth mental health and addiction care and tested the three multilevel models of alliance at start of treatment and 2-month follow-up. Our results suggests a two-factor model for youth and a three-dimensional model for their therapist at both time points. Since this is the first study that finds a best fit for a two-dimensional construct of alliance in youth, more research is needed to rule out whether the differences in alliance dimensions are due to measurement differences between the WAI-SR for youth and therapists or whether youth and their therapists truly differ in their perceptions of the concept of alliance.