The development of the therapeutic working alliance, patients' awareness and their compliance during the process of brain injury rehabilitation

• Published in: Brain injury Vol. 20; no. 4; pp. 445 - 454
• Main Authors: Schönberger, Michael, Humle, Frank, Teasdale, Thomas W.
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 01-04-2006; Taylor & Francis
• Subjects: acquired brain injury; Adult; Attitude of Health Personnel; Awareness; Brain Injuries - rehabilitation; compliance; Female; Holistic Health; Humans; Male; Middle Aged; Object Attachment; Patient Compliance - psychology; process research; Professional-Patient Relations; Prospective Studies; rehabilitation; Rehabilitation - methods; Stroke Rehabilitation; Therapeutic working alliance
• ISSN: 0269-9052; 1362-301X
• DOI: 10.1080/02699050600664772

Purpose: To examine the development and interaction of the therapeutic alliance, patients' compliance and awareness during the process of brain injury rehabilitation and the role of demographic and injury related variables in this process. Subjects were 86 patients who underwent a holistic neuropsychological outpatient rehabilitation programme. Patients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10).
Measures: The therapeutic alliance between clients and their primary therapists, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists.
Results: The development of the process measures over time is described in the article. Clients' and therapists' perspectives on their alliance tended to converge over time. Clients' experience of their emotional bond with their therapist added as much to the prediction of clients' awareness as the localization of their brain injury. Clients' awareness was related to their compliance and mediated the impact of the therapeutic alliance on their compliance.
Discussion: A good working alliance is the basis of successful rehabilitative work. The article discusses therapeutic implications of the results.