THERAPEUTIC ALLIANCE AND REHAB OUTCOMES

Project Principal Investigator: Risa Nakase-Richardson, Ph.D

Background : Preliminary evidence suggests that “therapeutic alliance”, client acceptance of the post-acute brain injury rehabilitation program (PABIR), is predictive of client work status at 6 months post-discharge. A possible barrier to development of a strong therapeutic alliance between clients and therapists is impaired self-awareness, which refers to decreased awareness of impairments due to brain injury. Persons with TBI often overestimate their functional abilities. Consequently, clients with TBI and their therapists are likely to disagree not only about deficits but about the therapeutic tasks that would address deficits and the goals of these therapeutic tasks. Poor agreement on tasks and goals of therapy and a poor bond may mean a poor therapeutic alliance and a poor outcome from treatment.

While family members generally perceive deficits of the person with TBI more similarly to the therapist than to the person with TBI, there is still substantial disagreement between family members and therapists. This disagreement in perceptions of client’s impairment may limit the development of therapeutic alliance between family and the treatment team.

There has been no investigation of factors that influence development of therapeutic alliances between clients and therapists and between family members and therapists, factors that determine quality of working alliances, or intervention to improve working alliances.

Research Goals

Goal 1 – Confirm and extend previous findings indicating that client therapeutic alliance with therapists in PABIR and family therapeutic alliance with therapists in PABIR are predictive of functional outcomes including community integration, personal independence, and productivity.

Goal 2 – Determine client, family, and therapist attributes, as well as characteristics of PABIR program structure, that contribute to development of strong client and family therapeutic alliance.

Goal 3 – Develop a new intervention that can be integrated into existing PABIR activities to strengthen client and family therapeutic alliance.

Goal 4 – Conduct a clinical trial of the new intervention to strengthen client and family therapeutic alliance.