A First Look at the Working Alliance in Psychotherapy With American Indians

We could find no published studies measuring the working alliance in outpatient psychotherapy with American Indians. Given that the working alliance has been shown to be one of the most reliable and robust predictors of outcome across psychotherapeutic modalities, we sought to understand the working alliance in this population. Eight psychotherapists in an urban outpatient clinic rated their working alliance with American Indian patients (n = 112) immediately after treatment delivery using the Working Alliance Inventory, 12-item short form (Tracey & Kokotovic, 1989). Working alliance data from 112 sessions were collected and compared with data from the Working Alliance Inventory, 12-item short form, normative sample (Busseri & Tyler, 2003). Therapist-rated working alliance in psychotherapy with American Indian patients was higher than a comparison sample. Alliance was unaffected by patient, therapist, or therapy-related variables in this sample. The working alliance is likely to be an important construct in psychotherapy with American Indian patients. Replication with a larger, representative group of therapists as well as the collection of patient and observer ratings are important next steps. Clinical Impact Statement Question: As it has not been investigated previously, we wondered what the working alliance is like in psychotherapy with American Indian outpatients. Findings: Therapist-rated working alliance was high, compared with a normative sample, and unaffected by potential covariates in 112 psychotherapy sessions with American Indian outpatients. Meaning: The working alliance appears to be an important ingredient in psychotherapy with this understudied and underserved population. Next Steps: Multiple raters and settings should be investigated to create a more comprehensive picture of the working alliance in psychotherapy with American Indian patients.