The Art Therapy Working Alliance Inventory: the development of a measure

ABSTRACT

Two studies present the development and validation of the Art Therapy Working Alliance Inventory measure, based on Bordin’s [1979. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252–260] conceptualisation of the therapeutic working alliance. The measure captures unique aspects of the art therapy working alliance that take into account the client’s relation to the art medium in the presence of the art therapist. The measure’s reliability and validity were examined. In Study 1, 40 art therapy students, who participated in art therapeutic simulations as clients during their training programme, rated the measure in its development phase; in Study 2, 104 art therapy students completed the final questionnaire and the Working Alliance Inventory in regard to therapeutic simulations. Exploratory factor analysis revealed three main factors: perceiving the art medium as an effective therapeutic tool (Art Task); the affective and explorative experience during art-making (Art Experience); and, acceptance of the art therapist’s interventions in the art medium (Art Therapist Acceptance). Associations were found between Art Task and Art Therapist Acceptance with each of the working alliance components, as well as between Art Experience with the Bond component. Implications for practice and research are discussed.

Plain-language summary

• In verbal psychotherapy, a strong therapeutic alliance between client and therapist is necessary to achieve therapeutic goals. In art therapy, this alliance includes a third object: the art medium, comprised of art materials, artmaking and artworks.

• In this study, we developed and tested a new questionnaire for art therapy service users which measures the client-art medium alliance formed in art therapy. The new questionnaire is based on the Working Alliance Inventory, a well-known measure used in psychotherapy (Horvath & Greenberg, 1989) and is called the Art Therapy-Working Alliance Inventory.

• In order to measure the alliance between the client and the art medium, the Art Therapy-Working Alliance Inventory asks about three main areas: the client’s perception of the art medium as a therapeutic tool (Art-Task), the client’s affective experience of his/her artwork (Art Experience), and the client’s acceptance/rejection of the art-therapist’s interventions in the art medium (Art Therapist Acceptance).

• We asked 104 art therapy students to assume the role of clients in simulated art therapy sessions and then fill out the questionnaire at the end. We found a strong association between the two alliance scores; in other words, the stronger the alliance between the client and the art therapist, the stronger the alliance between the client and the art medium.

• Thus, we concluded that the Art Therapy-Working Alliance Inventory can serve as a useful tool in the research of art therapy practice.

KEYWORDS:

• Working Alliance
• art therapy
• psychodynamic treatment
• measurement
• triangular relationship

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Michal Bat Or is an art therapist, and a lecturer in the School of Creative Arts Therapies, in the Faculty of Social Welfare & Health Sciences in the University of Haifa. Dr Bat Or is most interested in the therapeutic triangle in art therapy, art-based assessments as enabling mentalisation, and in art therapy in social action.

Sigal Zilcha-Mano is a licensed clinical psychologist, and Associate Professor of Clinical Psychology in the Department of Psychology, University of Haifa. She heads the Psychotherapy Research Lab in the Department of Psychology, University of Haifa. She is Associate Editor of the Journal of Counseling Psychology, and on the editorial board of Psychotherapy, and of Psychotherapy Research.