title: The 4-Point ordinal Alliance Self-report: a self-report questionnaire for assessing therapeutic relationships in routine mental health.
abstract: BACKGROUND
  The quality of the relationship between patient and therapist can be considered a cornerstone of psychiatric practice. Nonadherence is one of the leading problems affecting antipsychotic effectiveness in schizophrenic patients and represents a poor prognostic factor for schizophrenia. Among the factors influencing adherence, the clinician's style of communication and the therapeutic relationship (TR) are recognized as key points. The measures of TR have been broadly explored in psychotherapy process but have received little attention in the treatment of severe mental illness in the context of routine mental health. Our objective was to build a self-rating scale easy to use in clinical psychiatric practice to assess TR, including drug-taking aspects and the relationship with the clinician on a day-to-day basis. A secondary objective was to assess the scale's validity and the association between TR and adherence.
  
  
  METHODS
  The study was conducted with 92 consenting inpatients who met specified criteria for schizophrenia and schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Assessments of TR were obtained by the 4-Point ordinal Alliance Self-report and an 8-cm visual analog scale completed by the patient 1 week before discharge, after the remission of acute symptomatology. Adherence behavior was estimated with a new valid and reliable questionnaire called the Medication Adherence Rating Scale. Factor analysis was performed.
  
  
  RESULTS
  Internal consistency was assessed by calculating Cronbach alpha, which revealed a highly satisfactory value (alpha = .91). After oblique rotation was run, 2 understandable factors were extracted that we termed empathy experienced and psychoeducation.
  
  
  CONCLUSIONS
  Therapeutic relationship with the clinician can be considered a prerequisite for positive treatment course and outcome. The detection of subpopulations characterized by determinants of poor TR could be the first step toward improving schizophrenia prognosis linked to poor adherence.
authors.affiliation: Département de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, Bordeaux, France. dmisdrahi@ch-perrens.fr
authors.forename: David
authors.initials: D
authors.lastname: Misdrahi
authors.forename: Helene
authors.initials: H
authors.lastname: Verdoux
authors.forename: Christophe
authors.initials: C
authors.lastname: Lançon
authors.forename: Franck
authors.initials: F
authors.lastname: Bayle
mesh_terms: D000328:Adult; D000368:Aged; D005163:Factor Analysis, Statistical; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D025341:Principal Component Analysis; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology*; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D011795:Surveys and Questionnaires