The relationship between clients' cognitive functioning and the therapeutic working alliance in post-acute brain injury rehabilitation

Objective: To examine the impact of brain-injured patients' cognitive abilities on their working alliance (WA) with their therapist in post-acute rehabilitation. Design: Cognitive tests were administered to brain-injured individuals at the beginning of post-acute, holistic brain-injury rehabilitation. Clients as well as their primary therapists rated their mutual WA at four time points throughout a 14-week rehabilitation programme. Subjects consisted of 86 clients as well as their primary therapists. Clients had suffered a traumatic brain injury (n=27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10). Measures: (1) Neuropsychological tests of attention, memory and higher cognitive functions; ( 2) the Working Alliance Inventory, client and therapist short form. Results: Overall, the relationships between cognitive tests and WA ratings were weak. The tests of attention, memory and higher cortical functions were differentially related to clients' and therapists' view of their mutual WA at the different stages of their collaborative work. Discussion and conclusion: Clients' cognitive profile affects clients' and therapists' view of their WA in different ways. The weakness of the correlations between cognitive tests and WA ratings may indicate that a good WA is achievable also with clients with severe cognitive difficulties.