| RPT |
.|.|Working Alliance Inventory-Short Revised ||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB:
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>| |WAI-SR| Task Scale: <-Task Scale->| Bond Scale: <-Bond Scale->| Goal Scale: <-Goal Scale->||Questions and Answers||1. As
a result of these sessions I am clearer as to how I might be able to change.| <*Answer_5434*>|2. What I am doing in therapy gives me new ways of looking at my problem.| <*Answer_5435*>|3. I
believe my therapist likes me.| <*Answer_5436*>|4. My therapist and I collaborate on setting goals for my therapy.| <*Answer_5437*>|5. My therapist and I respect each other.|
<*Answer_5438*>|6. My therapist and I are working towards mutually agreed upon goals.| <*Answer_5439*>|7. I feel that my therapist appreciates me.| <*Answer_5440*>|8. My therapist and I agree
on what is important for me to work on.| <*Answer_5441*>|9. I feel my therapist cares about me even when I do things that he/she does not approve of.| <*Answer_5442*>|10. I feel that the things
I do in therapy will help me to accomplish the changes that I want.| <*Answer_5443*>|11. My therapist and I have established a good understanding of the kind of changes that|would be good for me.|
<*Answer_5444*>|12. I believe the way we are working with my problem is correct.| <*Answer_5445*>||Copyright (c) A. O. Horvath, 1981, 1982; Revision Tracey & Kokotowitc 1989|| $~
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