Alliance and cognitive rehabilitation outcomes (Rothbart et al., 2025)

Purpose: The purpose of this study was to experimentally evaluate the potential impact of clinician-driven therapy ingredients hypothesized to enhance working alliance (WA) and promote patient engagement during cognitive rehabilitation sessions. It was hypothesized that when the clinician introduced evidence-backed alliance enhancing ingredients, there would be a corresponding improvement in participants’ (a) performance on attention drills paired with a metacognitive strategy, (b) learning the steps to use a phone application, and (c) adherence to a home exercise program. It was also hypothesized that patients would show perceptual shifts toward stronger alliance.

Method: Four adult participants who sustained moderate to severe acquired brain injuries with chronic cognitive deficits participated in the study. The study used a concurrent multiple-baseline design with randomization. Both visual and quantitative analyses were used to compare potential differences in performance on cognitive rehabilitation tasks when specific alliance enhancing behaviors were integrated into sessions.

Results: Findings showed a strong effect for increased performance on attention span tasks when the clinician added the alliance enhancing treatment ingredients. Participants also learned more steps in the phone application task and either maintained or improved homework adherence in the experimental phase when the treatment ingredients were applied. The findings provided mixed results on participant perceptions of WA, as measured by a modified version of the Working Alliance Inventory.

Conclusions: This study provides some of the first experimental data demonstrating that alliance enhancing treatment ingredients can have a significant influence on patient performance during cognitive rehabilitation sessions. The article offers recommendations for building on this important line of study.

Supplemental Material S1. Task analysis activities.

Rothbart, A., Sohlberg, M. M., Shune, S., Seeley, J., Berkman, E., & Wright, J. (2025). Do treatment ingredients targeting working alliance improve cognitive rehabilitation session performance in patients with acquired brain injury? American Journal of Speech-Language Pathology, 34(3), 1023–1040. https://doi.org/10.1044/2024_AJSLP-24-00347