What predicts quality of the therapeutic alliance in a cognitive behavioural treatment for children with anxiety disorders? Therapeutic alliance measured from the patient, therapist and observer perspective

Abstract

This study assessed the quality of the therapeutic alliance in a cognitive-behavioural treatment for anxious children, and examined possible predictors of the alliance. Participants were 20 clients diagnosed with an anxiety disorder. The therapeutic alliance was measured from the patient, therapist, and observer perspective early and late in therapy. Predictors included in the study were: 1) background predictors (gender, age condition, and treatment format); 2) parental style; 3) self-concept; 4) symptom severity; and 5) motivation and treatment credibility. Firstly, results showed that patients' and therapists' alliance ratings were high and similar, while observer-rated alliance was lower. Secondly, the correlation between patient-, therapist-, and observer-rated alliance varied. There was a significant correlation between patient- and therapist-rated early alliance. No correlation was found between observer-rated alliance and patient-rated alliance. Observer-rated and therapist-rated alliance was significantly correlated. Thirdly, the therapeutic alliance was stable over time for all the perspectives. Fourthly, predictors of the alliance varied for the different perspectives. Predictors of patient-rated alliance were mother-rated treatment credibility and self concept. Predictors of therapist-rated alliance were motivation, mother-rated treatment credibility, gender (girls were rated higher) and patient-rated treatment credibility. Predictors of observer-rated alliance were patient motivation and an autonomous parental style.

Denne studien vurderte kvaliteten på den terapeutiske alliansen i en kognitiv adferdsterapi for engstelige barn, og undersøkte mulige prediktorer for allianse. Deltakerne var 20 klienter diagnostisert med en angstlidelse. Den terapeutiske alliansen ble målt fra pasient-, terapeut- og observatør perspektivet tidlig og sent i terapi. Prediktorer inkludert i studien var: 1) bakgrunnsvariabler (kjønn, aldersbetingelse og behandlingsformat); 2) foreldrestil; 3) selvbilde; 4) symptombelastning; og 5) motivasjon og behandlingstiltro. For det første viste resultatene at pasientenes og terapeutenes alliansebedømninger var høye og tilnærmet like, mens observatørbedømt allianse var lavere. For det andre varierte korrelasjonene mellom pasient-, terapeut- og observatørbedømt allianse. Det var en signifikant korrelasjon mellom pasientbedømt og terapeutbedømt tidlig allianse. Det var ingen korrelasjon mellom observatørbedømt og pasientbedømt allianse. Observatørbedømt og terapeutbedømt allianse var signifikant korrelert. For det tredje var den terapeutiske alliansen stabil over tid for alle perspektivene. For det fjerde varierte prediktorene for allianse for de ulike perspektivene. Prediktorer for pasientbedømt allianse var mors behandlingstiltro og pasientens selvbilde. Prediktorer for terapeutbedømt allianse var pasientens motivasjon, mors behandlingstiltro, kjønn (jenter ble bedømt høyere) og pasientens behandlingstiltro. Prediktorer for observatørbedømt allianse var pasientens motivasjon og en autonom foreldrestil.