Reliability and preliminary insights of adapting the Working Alliance Inventory Observer form for Bahasa Indonesia psychotherapy settings

ABSTRACT

Working alliance is a key predictor of therapy outcomes, and observer ratings offer an objective perspective. This study adapted the Working Alliance Inventory-Observer Form (WAI-O) for Bahasa Indonesia psychotherapy settings. It involved 15 therapist-patient dyads and three expert observers. The study correlated third-session WAI-O scores with sixth-session therapist-rated improvements for predictive validity and with WAI-client and WAI-therapist scores for construct validity. The Indonesian WAI-O demonstrated moderate predictive validity, no significant convergent validity, and excellent reliability, with a Cronbach’s alpha of 0.994 and an ICC of 0.628. Preliminary evidence supports the Indonesian WAI-O’s reliability and potential validity for predicting overall clinical improvement, but further research with a larger sample size is suggested to fully establish its validity.

KEYWORDS:

• Observer ratings
• predictive validity
• psychotherapy
• reliability
• working alliance inventory

Acknowledgments

We thank the Society for Psychotherapy Research for granting the permission to use and translate the Working Alliance Inventory. We thank Prof. Adam O. Horvath and Dr Timothy Anderson for their assistance and comments during the translation process. We thank Dr. Heriani Tobing, SpKJ(K) for her expertise and dedication in assisting with the translation and cultural adaptation of the instrument.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Leonita Ariesti Putri

Leonita Ariesti Putri is an early career psychiatrist who was still a psychiatry resident at Universitas Indonesia during this research under the supervision of the other co-authors. She received a bachelor’s degree in medicine from Universitas Indonesia in 2015 and a master’s degree in Psychoanalytic Developmental Psychology from University College London in 2018. She just recently completed her psychiatry residency in 2024. She is interested in psychotherapy and has a special interest in the child-adolescent population.

Sylvia Detri Elvira

Sylvia Detri Elvira is renowned for her expertise in Psychotherapy, holding the position of head of the Psychotherapy Division at the Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital. In 2005, she obtained her Consultant title in Psychotherapy from the Indonesian Psychiatric Association. Her areas of expertise include psychotherapy, psychodynamics, hypnotherapy, and women’s mental health.

Feranindhya Agiananda

Feranindhya Agianandha specializes in Consultation-Liaison Psychiatry and is a staff member in the Consultation Liaison Psychiatry Division at the Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital. In 2014, she was awarded the title of Consultant in Consultation Liaison Psychiatry by the Indonesian Psychiatric Association.

Petrin Redayani Lukman

Petrin Redayani Lukman specializes in Psychotherapy and works as a staff member in the Psychotherapy Division at the Department of Mental Health Sciences, Faculty of Medicine, University of Indonesia - Dr. Cipto Mangunkusumo General Hospital. She attained a Master’s degree in Medical Education from the University of Indonesia in 2011 and was awarded the title of Consultant in Psychotherapy by the Indonesian Psychiatric Association in 2013.