{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:41:40Z","timestamp":1792658500988,"version":"4.5.0"},"reference-count":68,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000051","name":"National Human Genome Research Institute","doi-asserted-by":"publisher","award":["R01HG011916"],"award-info":[{"award-number":["R01HG011916"]}],"id":[{"id":"10.13039\/100000051","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002494"],"award-info":[{"award-number":["UL1TR002494"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Genetic Counseling"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The Reciprocal Engagement Model of genetic counseling practice centers the patient\u2010provider relationship as an essential component of practice, but few quantitative studies have assessed what influences this relationship in actual genetic counseling practice. Our study explored which factors are most strongly associated with the patient\u2010perceived bond subscale of the Working Alliance Inventory in a variety of genetic counseling sessions using a diverse patient sample across multiple clinical specialties. There were 416 participants (50.4% non\u2010Hispanic white) seen by 41 genetic counselors (95.1% non\u2010Hispanic white) in a variety of specialty clinics, session modalities, and session types (i.e., pre\u2010 vs. post\u2010test) as part of Stage 1 of the GC\u2010PRO study, which investigated how in\u2010session processes affect patient\u2010reported outcomes at two academic institutions and one telehealth company. Participants completed multiple validated scales measuring patient empowerment, satisfaction, decisional conflict, and other patient experience measures (e.g., working alliance and patient\u2010centered communication). Using hierarchical linear regression modeling, predictors of the bond between participants and their genetic counselors were assessed. There were 6 significant predictors in the final model (\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>\n                      <jats:italic>2<\/jats:italic>\n                    <\/jats:sup>\n                    <jats:sub>\n                      <jats:italic>a<\/jats:italic>\n                    <\/jats:sub>\n                    \u2009=\u20090.45). Higher patient\u2010reported bond scores were associated with younger participants, Black participants, more patient\u2010centered communication, higher patient\u2010perceived levels of autonomy support, higher post\u2010session patient\u2010reported empowerment, and higher session satisfaction levels. Patient autonomy and empowerment had the largest effects and thus may be the most efficient path toward improving bond, but further research is needed to determine causal directionality. Few demographic categories were associated with a diminished bond score, suggesting that patients were generally able to connect with their genetic counselor equally well, though Black patients' stronger bonds merits further exploration.\n                  <\/jats:p>","DOI":"10.1002\/jgc4.70308","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:23:33Z","timestamp":1792657413000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Insights Into Working Alliance: Predictors of Patient\u2010Perceived Bond With Genetic Counselors Among a Diverse, Multispecialty Sample"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0896-1952","authenticated-orcid":false,"given":"Ian M.","family":"MacFarlane","sequence":"first","affiliation":[{"name":"Department of Genetics, Cell Biology, and Development University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7560-1826","authenticated-orcid":false,"given":"Elena R.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Genetics, Cell Biology, and Development University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-2857","authenticated-orcid":false,"given":"Deborah","family":"Cragun","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, College of Public Health University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-664X","authenticated-orcid":false,"given":"Heather A.","family":"Zierhut","sequence":"additional","affiliation":[{"name":"Department of Genetics, Cell Biology, and Development University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"Accreditation Council for Genetic Counseling (ACGC).2023.\u201cPractice\u2010Based Competencies for Genetic Counselors.\u201dhttps:\/\/www.gceducation.org\/wp\u2010content\/uploads\/2023\/12\/ACGC_PracticeBasedCompetencies_2023.pdf."},{"key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1177\/1362361319849985","article-title":"Predictors and Outcomes Associated With Therapeutic Alliance in Cognitive Behaviour Therapy for Children With Autism","volume":"24","author":"Albaum C.","year":"2020","journal-title":"Autism"},{"issue":"3","key":"e_1_2_14_4_1","first-page":"173","article-title":"The Factor Structure of the Working Alliance Inventory in Cognitive\u2010Behavioral Therapy","volume":"10","author":"Andrusyna T. P.","year":"2001","journal-title":"Journal of Psychotherapy Practice and Research"},{"issue":"12","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.gim.2024.101279","article-title":"Group\u2010Based Medical Mistrust in Genomic Medicine: Associations With Patient and Provider Perceptions of a Specialty Clinical Encounter","volume":"26","author":"Angelo F.","year":"2024","journal-title":"Genetics in Medicine"},{"issue":"2","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1080\/08964289.2019.1588220","article-title":"Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust","volume":"45","author":"Benkert R.","year":"2019","journal-title":"Behavioral Medicine"},{"issue":"3","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1037\/h0085885","article-title":"The Generalizability of the Psychoanalytic Concept of the Working Alliance","volume":"16","author":"Bordin E. S.","year":"1979","journal-title":"Psychotherapy: Theory, Research & Practice"},{"issue":"1","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/0011000083111007","article-title":"A Working Alliance Based Model of Supervision","volume":"11","author":"Bordin E. S.","year":"1983","journal-title":"Counseling Psychologist"},{"issue":"3","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s11136-022-03289-7","article-title":"Using Rasch Measurement Theory to Explore the Fitness for Purpose of the Genetic Counseling Outcome Scale: A Tale of Two Scales","volume":"32","author":"Borle K.","year":"2023","journal-title":"Quality of Life Research"},{"issue":"5","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1002\/nur.20158","article-title":"The Health Care Relationship (HCR) Trust Scale: Development and Psychometric Evaluation","volume":"29","author":"Bova C.","year":"2006","journal-title":"Research in Nursing & Health"},{"issue":"1","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","DOI":"10.1002\/jgc4.1844","article-title":"Measuring the Therapeutic Bond in Genetic Counseling: Testing Measurement Error in the Bond Subscale of the Working Alliance Inventory","volume":"34","author":"Broadbridge E.","year":"2025","journal-title":"Journal of Genetic Counseling"},{"issue":"1","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1159\/000356013","article-title":"Knowledge, Group\u2010Based Medical Mistrust, Future Expectations, and Perceived Disadvantages of Medical Genetic Testing: Perspectives of Black African Immigrants\/Refugees","volume":"17","author":"Buseh A.","year":"2014","journal-title":"Public Health Genomics"},{"issue":"1","key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/jgc4.1485","article-title":"Contributors to and Consequences of Burnout Among Clinical Genetic Counselors in the United States","volume":"31","author":"Caleshu C.","year":"2022","journal-title":"Journal of Genetic Counseling"},{"issue":"6","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"832","DOI":"10.7326\/0003-4819-92-6-832","article-title":"Information and Participation Preferences Among Cancer Patients","volume":"92","author":"Cassileth B. R.","year":"1980","journal-title":"Annals of Internal Medicine"},{"issue":"1","key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1037\/ser0000582","article-title":"The Association Between Patient\u2013Provider Racial\/Ethnic Concordance, Working Alliance, and Length of Treatment in Behavioral Health Settings","volume":"20","author":"Cheng A. W.","year":"2023","journal-title":"Psychological Services"},{"issue":"5","key":"e_1_2_14_16_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s11606-008-0520-5","article-title":"Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population","volume":"23","author":"Chew L. D.","year":"2008","journal-title":"Journal of General Internal Medicine"},{"key":"e_1_2_14_17_1","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J.","year":"1988"},{"issue":"2","key":"e_1_2_14_18_1","doi-asserted-by":"crossref","DOI":"10.1177\/2055102917730675","article-title":"Validation of the English and French Versions of the Brief Health Care Climate Questionnaire","volume":"4","author":"Czajkowska Z.","year":"2017","journal-title":"Health Psychology Open"},{"issue":"7","key":"e_1_2_14_19_1","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1002\/pon.4233","article-title":"Patient Satisfaction and Alliance as a Function of the Physician's Self\u2010Regulation, the Physician's Stress, and the Content of Consultation in Cancer Care","volume":"26","author":"De Vries A. M. M.","year":"2017","journal-title":"Psycho\u2010Oncology"},{"issue":"4","key":"e_1_2_14_20_1","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1023\/B:JOGC.0000035523.96133.bc","article-title":"Patient Satisfaction With Cancer Genetic Counseling: A Psychometric Analysis of the Genetic Counseling Satisfaction Scale","volume":"13","author":"DeMarco T. A.","year":"2004","journal-title":"Journal of Genetic Counseling"},{"issue":"2","key":"e_1_2_14_21_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1080\/10503307.2014.954153","article-title":"The Working Alliance: Where Have We Been, Where Are We Going?","volume":"26","author":"Doran J. M.","year":"2016","journal-title":"Psychotherapy Research"},{"issue":"1","key":"e_1_2_14_22_1","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1007\/s10488-016-0779-5","article-title":"The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care","volume":"45","author":"Eliacin J.","year":"2018","journal-title":"Administration and Policy in Mental Health and Mental Health Services Research"},{"issue":"1","key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/jgc4.1378","article-title":"Adaptation of the Working Alliance Inventory for the Assessment of the Therapeutic Alliance in Genetic Counseling","volume":"30","author":"Erby L. H.","year":"2021","journal-title":"Journal of Genetic Counseling"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102024\u2010085472"},{"issue":"6","key":"e_1_2_14_25_1","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1037\/cou0000424","article-title":"Assessing the Alliance\u2013Outcome Association Adjusted for Patient Characteristics and Treatment Processes: A Meta\u2010Analytic Summary of Direct Comparisons","volume":"67","author":"Fl\u00fcckiger C.","year":"2020","journal-title":"Journal of Counseling Psychology"},{"issue":"1","key":"e_1_2_14_26_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.pec.2006.09.013","article-title":"The Physician\u2013Patient Working Alliance","volume":"66","author":"Fuertes J. N.","year":"2007","journal-title":"Patient Education and Counseling"},{"issue":"4","key":"e_1_2_14_27_1","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1080\/08964289.2015.1122569","article-title":"The Physician\u2013Patient Working Alliance in Hemodialysis Treatment","volume":"43","author":"Fuertes J. N.","year":"2017","journal-title":"Behavioral Medicine"},{"issue":"4","key":"e_1_2_14_28_1","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.pec.2016.10.018","article-title":"The Physician\u2010Patient Working Alliance: Theory, Research, and Future Possibilities","volume":"100","author":"Fuertes J. N.","year":"2017","journal-title":"Patient Education and Counseling"},{"issue":"1","key":"e_1_2_14_29_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1080\/10503300500352500","article-title":"Development and Validation of a Revised Short Version of the Working Alliance Inventory","volume":"16","author":"Hatcher R. L.","year":"2006","journal-title":"Psychotherapy Research"},{"issue":"8","key":"e_1_2_14_30_1","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1080\/09638288.2022.2060337","article-title":"Working Alliance Inventory (WAI) and Its Relationship to Patient\u2010Reported Outcomes in Painful Musculoskeletal Conditions","volume":"45","author":"Holmes M. B.","year":"2023","journal-title":"Disability and Rehabilitation"},{"issue":"2","key":"e_1_2_14_31_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1037\/0022-0167.36.2.223","article-title":"Development and Validation of the Working Alliance Inventory","volume":"36","author":"Horvath A. O.","year":"1989","journal-title":"Journal of Counseling Psychology"},{"issue":"4","key":"e_1_2_14_32_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1037\/0022-006X.61.4.561","article-title":"The Role of the Therapeutic Alliance in Psychotherapy","volume":"61","author":"Horvath A. O.","year":"1993","journal-title":"Journal of Consulting and Clinical Psychology"},{"issue":"2","key":"e_1_2_14_33_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1037\/0022-0167.38.2.139","article-title":"Relation Between Working Alliance and Outcome in Psychotherapy: A Meta\u2010Analysis","volume":"38","author":"Horvath A. O.","year":"1991","journal-title":"Journal of Counseling Psychology"},{"issue":"1","key":"e_1_2_14_34_1","doi-asserted-by":"crossref","DOI":"10.3399\/bjgpopen20X101131","article-title":"Exploring the Psychometric Properties of the Working Alliance Inventory in General Practice: A Cross\u2010Sectional Study","volume":"5","author":"Hunik L.","year":"2021","journal-title":"BJGP Open"},{"issue":"1","key":"e_1_2_14_35_1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.pec.2013.09.016","article-title":"The Cancer Information Overload (CIO) Scale: Establishing Predictive and Discriminant Validity","volume":"94","author":"Jensen J. D.","year":"2014","journal-title":"Patient Education and Counseling"},{"issue":"6","key":"e_1_2_14_36_1","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1177\/2374373519895680","article-title":"Patient\u2013Provider Relationships Among Vulnerable Patients: The Association With Health Literacy, Continuity of Care, and Self\u2010Rated Health","volume":"7","author":"Kamimura A.","year":"2020","journal-title":"Journal of Patient Experience"},{"issue":"1","key":"e_1_2_14_37_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.7205\/MILMED.173.1.85","article-title":"The Quality of Therapeutic Alliance Between Patient and Provider Predicts General Satisfaction","volume":"173","author":"Kim S. C.","year":"2008","journal-title":"Military Medicine"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/160940690800700102"},{"issue":"2","key":"e_1_2_14_39_1","doi-asserted-by":"crossref","DOI":"10.1002\/jgc4.70179","article-title":"A Mixed Methods Approach to Understanding Patient Outcomes in Cardiovascular Genetic Counseling","volume":"35","author":"Lewis E.","year":"2026","journal-title":"Journal of Genetic Counseling"},{"issue":"2","key":"e_1_2_14_40_1","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s10447-024-09546-3","article-title":"Clients' Race\/Ethnicity as a Moderator of the Relationship Between the Therapeutic Alliance and Treatment Outcome","volume":"46","author":"Li Y.","year":"2024","journal-title":"International Journal for the Advancement of Counselling"},{"issue":"3","key":"e_1_2_14_41_1","doi-asserted-by":"crossref","first-page":"194","DOI":"10.17294\/2330-0698.1562","article-title":"Acculturation and Patient\u2010Reported Experience With Health Care: An In\u2010Depth Examination Using CG\u2010CAHPS Surveys, Electronic Health Records, and Patient Surveys","volume":"4","author":"Liang S. L.","year":"2017","journal-title":"Journal of Patient\u2010Centered Research and Reviews"},{"issue":"7318","key":"e_1_2_14_42_1","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1136\/bmj.323.7318.908","article-title":"Observational Study of Effect of Patient Centredness and Positive Approach on Outcomes of General Practice Consultations","volume":"323","author":"Little P.","year":"2001","journal-title":"BMJ"},{"issue":"4","key":"e_1_2_14_43_1","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.pec.2019.10.016","article-title":"Individuation and Implicit Racial Bias in Genetic Counseling Communication","volume":"103","author":"Lowe C.","year":"2020","journal-title":"Patient Education and Counseling"},{"issue":"4","key":"e_1_2_14_44_1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1176\/appi.psychotherapy.20230056","article-title":"Patients' Perceptions of Their Therapist: Effects of Race, Culture, and Cultural Competency on the Working Alliance","volume":"77","author":"Lukowitsky M. R.","year":"2024","journal-title":"American Journal of Psychotherapy"},{"issue":"3","key":"e_1_2_14_45_1","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1037\/a0028907","article-title":"Relationships Among Client and Counselor Agreement About the Working Alliance, Session Evaluations, and Change in Client Symptoms Using Response Surface Analysis","volume":"59","author":"Marmarosh C. L.","year":"2012","journal-title":"Journal of Counseling Psychology"},{"issue":"3","key":"e_1_2_14_46_1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1037\/0022-006X.68.3.438","article-title":"Relation of the Therapeutic Alliance With Outcome and Other Variables: A Meta\u2010Analytic Review","volume":"68","author":"Martin D. J.","year":"2000","journal-title":"Journal of Consulting and Clinical Psychology"},{"issue":"6","key":"e_1_2_14_47_1","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s10897-007-9113-4","article-title":"Coming Full Circle: A Reciprocal\u2010Engagement Model of Genetic Counseling Practice","volume":"16","author":"McCarthy Veach P.","year":"2007","journal-title":"Journal of Genetic Counseling"},{"key":"e_1_2_14_48_1","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/j.1360-0443.2005.01031.x","article-title":"Predicting the Early Therapeutic Alliance in the Treatment of Drug Misuse","volume":"100","author":"Meier P. S.","year":"2005","journal-title":"Addiction"},{"issue":"2","key":"e_1_2_14_49_1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1037\/cou0000564","article-title":"Ceiling Effects Indicate a Possible Threshold Structure for Working Alliance","volume":"69","author":"Meier S. T.","year":"2022","journal-title":"Journal of Counseling Psychology"},{"issue":"2","key":"e_1_2_14_50_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.pec.2012.10.013","article-title":"Working Alliance in Communication Skills Training for Oncology Clinicians: A Controlled Trial","volume":"90","author":"Meystre C.","year":"2013","journal-title":"Patient Education and Counseling"},{"issue":"3","key":"e_1_2_14_51_1","doi-asserted-by":"crossref","DOI":"10.1002\/jgc4.1998","article-title":"Assessing and Attending to Psychosocial Concerns in Genetic Counseling: Proposing the BATHE Method","volume":"34","author":"Moscarello T.","year":"2025","journal-title":"Journal of Genetic Counseling"},{"issue":"12","key":"e_1_2_14_52_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0279725","article-title":"Patient\u2010Centered Communication (PCC) Scale: Psychometric Analysis and Validation of a Health Survey Measure","volume":"17","author":"Moser R. P.","year":"2022","journal-title":"PLoS One"},{"issue":"2","key":"e_1_2_14_53_1","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1002\/jgc4.1499","article-title":"Strength of the Genetic Counselor: Patient Relationship Is Associated With Extent of Increased Empowerment in Patients With Arrhythmogenic Cardiomyopathy","volume":"31","author":"Murray B.","year":"2022","journal-title":"Journal of Genetic Counseling"},{"key":"e_1_2_14_54_1","unstructured":"National Society of Genetic Counselors.2024.\u201c2024 Professional Status Survey.\u201dhttps:\/\/www.nsgc.org\/Policy\u2010Research\u2010and\u2010Publications\/Professional\u2010Status\u2010Survey."},{"key":"e_1_2_14_55_1","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1002\/cpp.2534","article-title":"What Do These Sounds Tell Us About the Therapeutic Alliance: Acoustic Markers as Predictors of Alliance","volume":"28","author":"Nof A.","year":"2021","journal-title":"Clinical Psychology & Psychotherapy"},{"issue":"3","key":"e_1_2_14_56_1","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/14733145.2010.491551","article-title":"Cultural Ruptures in Short\u2010Term Therapy: Working Alliance as a Mediator Between Clients' Perceptions of Microaggressions and Therapy Outcomes","volume":"11","author":"Owen J.","year":"2011","journal-title":"Counselling and Psychotherapy Research"},{"key":"e_1_2_14_57_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/med-psych\/9780190868529.003.0002","volume-title":"Working Alliance Skills for Mental Health Professionals","author":"P\u00e9rez\u2010Rojas A. E.","year":"2019"},{"issue":"2","key":"e_1_2_14_58_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s10897-015-9864-2","article-title":"Defining Our Clinical Practice: The Identification of Genetic Counseling Outcomes Utilizing the Reciprocal Engagement Model","volume":"25","author":"Redlinger\u2010Grosse K.","year":"2016","journal-title":"Journal of Genetic Counseling"},{"issue":"6","key":"e_1_2_14_59_1","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1007\/s10897-017-0114-7","article-title":"Elaboration of the Reciprocal\u2010Engagement Model of Genetic Counseling Practice: A Qualitative Investigation of Goals and Strategies","volume":"26","author":"Redlinger\u2010Grosse K.","year":"2017","journal-title":"Journal of Genetic Counseling"},{"key":"e_1_2_14_60_1","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.jad.2011.12.044","article-title":"Interpersonal Problems as Predictors of Therapeutic Alliance and Symptom Improvement in Cognitive Therapy for Depression","volume":"138","author":"Renner F.","year":"2012","journal-title":"Journal of Affective Disorders"},{"issue":"1","key":"e_1_2_14_61_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.pec.2012.09.006","article-title":"Health Literacy and Patient Empowerment in Health Communication: The Importance of Separating Conjoined Twins","volume":"90","author":"Schulz P. J.","year":"2013","journal-title":"Patient Education and Counseling"},{"key":"e_1_2_14_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0027\u20109684(15)30081\u2010X"},{"issue":"3","key":"e_1_2_14_63_1","doi-asserted-by":"crossref","first-page":"103","DOI":"10.3390\/nursrep15030103","article-title":"Medical Mistrust: A Concept Analysis","volume":"15","author":"Shukla M.","year":"2025","journal-title":"Nursing Reports"},{"issue":"2","key":"e_1_2_14_64_1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1002\/jgc4.1230","article-title":"Racial and Ethnic Differences in Genetic Counseling Experiences and Outcomes in the United States: A Systematic Review","volume":"29","author":"Southwick S. V.","year":"2020","journal-title":"Journal of Genetic Counseling"},{"issue":"4","key":"e_1_2_14_65_1","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1093\/fampra\/cmy113","article-title":"Adaption and Validation of the Working Alliance Inventory for General Practice: Qualitative Review and Cross\u2010Sectional Surveys","volume":"36","author":"Sturgiss E. A.","year":"2019","journal-title":"Family Practice"},{"issue":"1","key":"e_1_2_14_66_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/08964289.2020.1870430","article-title":"Physicians' and Patients' Ratings of the Physician\u2010Patient Working Alliance, Adherence, Satisfaction, and Treatment Outcome","volume":"48","author":"Toporovsky A.","year":"2022","journal-title":"Behavioral Medicine"},{"issue":"4","key":"e_1_2_14_67_1","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.14485\/HBPR.11.4.2","article-title":"The Role of Health Literacy in Patient\u2010Physician Communication: A Scoping Review","volume":"11","author":"Vamos S. D.","year":"2024","journal-title":"Health Behavior and Policy Review"},{"key":"e_1_2_14_68_1","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1097\/MLR.0b013e3182652482","article-title":"Development and Evaluation of CAHPS Survey Items Assessing How Well Healthcare Providers Address Health Literacy","volume":"50","author":"Weidmer B. A.","year":"2012","journal-title":"Medical Care"},{"issue":"4","key":"e_1_2_14_69_1","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1037\/0735-7028.36.4.400","article-title":"Do Gender and Racial Differences Between Patient and Therapist Affect Therapeutic Alliance and Treatment Retention in Adolescents?","volume":"36","author":"Wintersteen M. B.","year":"2005","journal-title":"Professional Psychology: Research and Practice"}],"container-title":["Journal of Genetic Counseling"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgc4.70308","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jgc4.70308","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgc4.70308","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:23:42Z","timestamp":1792657422000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgc4.70308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":68,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jgc4.70308"],"URL":"https:\/\/doi.org\/10.1002\/jgc4.70308","archive":["Portico"],"relation":{},"ISSN":["1059-7700","1573-3599"],"issn-type":[{"value":"1059-7700","type":"print"},{"value":"1573-3599","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70308"}}