Luborsky's concept of the "helping alliance" refers to a patient's experience of the treatment or relationship with a therapist as being helpful or potentially helpful. The quality of the patient-therapist relationship can be assessed by asking the patient, the therapist, or an (objective) observer. The Helping Alliance Questionnaire is part of the Penn Helping Alliance Scales and is a patient self-report measure which assesses the extent to which the patient experiences the therapist and the therapy as helpful. It contains two types of helping alliance: Type I -- Perceived Helpfulness -- defined as the patient's experience of the therapist as providing or being capable of providing the help that is needed; and Type II -- Collaboration or Bonding -- defined as the patient's experience of treatment as a process of working together with the therapist toward the goals of treatment. The HAQ contains 11 items rated on a 4-point scale (completely disagree, disagree, agree, and completely agree). There are two versions of the HAq -- a version for the patient, asking questions regarding their relationship with their therapist ("I feel I can depend upon the therapist," e.g.), and a version for the therapist, asking the same questions in reverse ("The patient feels he/she can depend upon me.") A revised version of the HAq, the HAq-II, was published by Luborsky et al. in 1996 (see Other References, below). The authors had become aware that the original HAQ was limited by the presence of items that were explicity assessing early symptomatic improvement and by the fact that all the items were worded positively. To address those limitations, they deleted the six items reflecting early improvement and added 14 new items that appeared to tap more fully the various aspects of the helping alliance. Five of the new items relate to the collaborative effort of patient and therapist ("The therapist and I have meaningful exchanges," e.g.); five additional items address the patient's perception of the therapist ("At times I distrust the therapist's judgement," e.g.). One of the other added items deals directly with the patient's motivation ("I want very much to work out my problems"), and one other relates to the patient's perception of the therapist's feelings about the patient ("I believe that the therapist likes me as a person"). In contrast to the original HAq, the HAq-II also includes five items that are worded negatively; for example, "The procedures used in my therapy are NOT well suited to my needs."