Long Form‚ Client
1. I feel uncomfortable with _____.
2. _____ and I agree about the things I will need to do in therapy to help improve my situation.
3. I am worried about the outcome of these sessions.
4. What I am doing in therapy gives me new ways of looking at my problem.
5. _____ and I understand each other.
6. _____ perceives accurately what my goals are.
7. I find what I am doing in therapy confusing.
8. I believe _____ likes me.
9. I wish _____ and I could clarify the purpose of our sessions.
10.I disagree with _____ about what I ought to get out of therapy.
11.I believe the time _____ and I are spending together is not spent efficiently.
12._____ does not understand what I am trying to accomplish in therapy.
13.I am clear on what my responsibilities are in therapy.
14.The goals of these sessions are important to me.
15.I find what _____ and I are doing in therapy is unrelated to my concerns.
16.I feel that the things I do in therapy will help me to accomplish the changes that I want.
17.I believe _____ is genuinely concerned for my welfare.
18.I am clear as to what _____ wants me to do in these sessions.
19._____ and I respect each other.
20.I feel that _____ is not totally honest about his/her feelings toward me.
21.I am confident in _____’s ability to help me.
22._____ and I are working towards mutually agreed upon goals.
23.I feel that _____ appreciates me.
24.We agree on what is important for me to work on.
25.As a result of these sessions I am clearer as to how I might be able to change.
26._____ and I trust one another.
27._____ and I have different ideas on what my problems are.
28.My relationship with _____ is very important to me.
29.I have the feeling that if I say or do the wrong things‚ _____ will stop working with me.
30._____ and I collaborate on setting goals for my therapy.
31.I am frustrated by the things I am doing in therapy.
32.We have established a good understanding of the kind of changes that would be good for me.
33.The things that _____ is asking me to do don’t make sense.
34.I don’t know what to expect as the result of my therapy.
35.I believe the way we are working with my problem is correct.
36.I feel _____ cares about me even when I do things that he/she does not approve of.
Long Form‚ Therapist/helper
فرم بلند برای درمانگر
1. I feel uncomfortable with _______________.
2. _______________ and I agree about the steps to be taken to improve his/her situation.
3. I have some concerns about the outcome of these sessions.
4. My client and I both feel confident about the usefullness of our current activity in therapy.
5. I feel I really understand _______________.
6. _______________ and I have a common perception of her/his goals..
7. _______________ finds what we are doing in therapy confusing.
8. I believe _______________ likes me.
9. I sense a need to clarify the purpose of our session(s) for _______________.
10.I have some disagreements with _______________ about the goals of these sessions.
11.I believe the time _______________ and I are spending together is not spent efficiently.
12.I have doubts about what we are trying to accomplish in therapy.
13.I am clear and explicit about what _______________'s responsibilities are in therapy.
14.The current goals of these sessions are important for _______________.
15.I find what _______________ and I are doing in therapy is unrelated to her/his current concerns.
16.I feel confident that the things we do in therapy will help _______________ to accomplish the changes that he/she desires.
17.I am genuinely concerned for _______________'s welfare.
18.I am clear as to what I expect _______________ to do in these sessions.
19._______________ and I respect each other.
20.I feel that I am not totally honest about my feelings toward _______________.
21.I am confident in my ability to help _______________.
22.We are working towards mutually agreed upon goals.
23.I appreciate _______________ as a person.
24.We agree on what is important for _______________ to work on.
25.As a result of these sessions _______________ is clearer as to how she/he might be able to change.
26._______________ and I have built a mutual trust.
27._______________ and I have different ideas on what his/her real problems are.
28.Our relationship is important to _______________.
29._______________ has some fears that if she/he says or does the wrong things‚ I will stop working with him/her.
30._______________ and I have collaborated in setting goals for these session(s).
31._______________ is frustrated by what I am asking her/him to do in therapy.
32.We have established a good understanding between us of the kind of changes that would be good for _______________.
33.The things that we are doing in therapy don't make much sense to _______________.
34._______________ doesn't know what to expect as the result of therapy.
35._______________ believes the way we are working with her/his problem is correct.
36.I respect _______________ even when he/she does things that I do not approve of.
Working Alliance Inventory – Short Revised (WAI-SR)
فرم کوتاه برای درمانجو
1. As a result of these sessions I am clearer as to how I might be able to change.
Seldom‚ Sometimes‚ Fairly Often‚ Very Often‚ Always
2. What I am doing in therapy gives me new ways of looking at my problem.
Always‚ Very Often‚ Fairly Often‚ Sometimes‚ Seldom
3. I believe ___likes me.
Seldom‚ Sometimes‚ Fairly Often‚ Very Often‚ Always
4. ___and I collaborate on setting goals for my therapy.
Seldom‚ Sometimes‚ Fairly Often‚ Very Often‚ Always
5. ___and I respect each other.
Always‚ Very Often‚ Fairly Often‚ Sometimes‚ Seldom
6. ___and I are working towards mutually agreed upon goals.
Always‚ Very Often‚ Fairly Often‚ Sometimes‚ Seldom
7. I feel that ___appreciates me.
Seldom‚ Sometimes‚ Fairly Often‚ Very Often‚ Always
8. _____ and I agree on what is important for me to work on.
Always‚ Very Often‚ Fairly Often‚ Sometimes‚ Seldom
9. I feel _____ cares about me even when I do things that he/she does not approve of.
Seldom‚ Sometimes‚ Fairly Often‚ Very Often‚ Always
10.I feel that the things I do in therapy will help me to accomplish the changes that I want.
Always‚ Very Often‚ Fairly Often‚ Sometimes‚ Seldom
11._____ and I have established a good understanding of the kind of changes that would be good for me.
Always‚ Very Often‚ Fairly Often‚ Sometimes‚ Seldom
12.I believe the way we are working with my problem is correct.
Seldom‚ Sometimes‚ Fairly Often‚ Very Often‚ Always
Goal Items: 4‚ 6‚ 8‚ 11; Task Items: 1‚ 2‚ 10‚ 12; Bond Items: 3‚ 5‚ 7‚ 9