Patients' view of the alliance in psychotherapy: Exploratory factor analysis of three alliance measures.

Extending a previous study (R.L. Hatcher, A. Barends, J. Hansell, & M.J. Gutfreund, 1995), factor analysis of 3 alliance measures completed by 231 patients explored patients' views of the alliance. Two of 6 factors, Confident Collaboration and Idealized Relationship (with the substantial general factor removed), correlated with patients' estimate of improvement (rs = .37 and -.23, respectively; p < .001). Patients view the core of the alliance as a purposive mutual collaboration, or working alliance; patients who acknowledge some hostility do better in therapy. Three other factors--Goals and Tasks, Bond, and Dedicated Patient--resemble established subscales but are unrelated to improvement beyond the general factor. Factor 6 assesses improvement rather than alliance. The collaborative working alliance should be given prominence in alliance theory and measurement.