Assessment of the therapeutic alliance of youth and parents with team members in youth residential psychiatry

Abstract

Although therapeutic alliance is widely acknowledged as a key component for therapeutic change, its role is almost unknown in youth residential psychiatry. A likely reason for the lack of research is the absence of assessment tools and procedures for youth residential settings. This study assesses the psychometric properties of the Dutch version of the Family Engagement Questionnaire (FEQ), an alliance measure completed by team members. In addition, agreement among team members is explored. Eleven youth psychiatric day and inpatient units participated. Parent counsellors and case managers of 86 patients from 6 to 17 years old reported on the therapeutic alliance. Exploratory factor analysis of team members' reports resulted in meaningful structures, with child and parent alliance scales primarily corresponding to the conceptualization of the developers and earlier factor analysis. Internal reliability and validity were good for most of the subscales. The hypothesis that team members would show low levels of agreement in their reports of the therapeutic alliance was confirmed, demonstrating the need to include multiple team members in assessment procedures. Overall, this study underscores the psychometric properties of the Dutch version of the FEQ. Team members in residential youth psychiatric settings are encouraged to reflect regularly with their colleagues on the youth and parent therapeutic alliance.

A dual perspective on first-session therapeutic alliance: strong predictor of youth mental health and addiction treatment outcome

“…Nevertheless, measuring alliance as early as possible is clinically relevant to allow its use as an early warning sign of potential patient dissatisfaction, premature treatment termination, and/or unfavorable treatment outcome. In addition, various authors have recommended that, when measuring therapeutic alliance, multiple informants should be involved, because different informants are likely to have different views on the quality of the therapeutic relationship [9,10]. Furthermore, it has been recommended that the alliance evaluations from these multiple sources should be incorporated to gain more insight into the alliance-treatment outcome association [11].…”

A Measure of the Parent-Team Alliance in Youth Residential Psychiatry: The Revised Short Working Alliance Inventory

“…The FEQ is designed to measure the youth and parental alliance in youth inpatient settings and originally consists of 18 items (Kroll and Green 1997 ). The FEQ was translated into Dutch by Lamers and Van Widenfelt ( 2014 ). In addition to two ‘Youth Alliance’ scales, the Dutch version of the FEQ consists of a ‘Parental Alliance’ scale.…”

Longitudinal results of strengthening the parent-team alliance in child semi-residential psychiatry: does team investment make a difference?

“…Commonly, therapeutic alliance is defined as the affective and collaborative aspects of the individual client-therapist relationship [ 1 ]. In youth mental health care, however, at least two therapeutic alliances are vigorous: the youth-therapist alliance and the parent-therapist alliance [ 2 ]. Interestingly, therapeutic alliances with parents of youth are associated with a wider range of positive outcomes than youth alliances only [ 3 – 5 ].…”

“…Due to the high costs and impact of (semi) residential psychiatric treatment in youth mental health care, refinement of effective strategies is a necessity. The importance of the therapeutic alliance with parents in (semi) residential settings is reflected in ample literature describing (a) the dynamics of the parent-treatment team alliance [ 20 ], (b) the perspectives of parents and treatment team members on their alliance [ 2 , 21 ], and (c) ways to positively influence the strength of the parent-treatment team alliance [ 22 , 23 ]. The parent-treatment team alliance has been identified as a critical component in relation to treatment success for youths in the (semi) residential setting [ 4 , 24 ].…”

“…The parent-treatment team alliance has been identified as a critical component in relation to treatment success for youths in the (semi) residential setting [ 4 , 24 ]. To elaborate on this research, several authors recommend investigating how the quality of the therapeutic alliance changes over time from different perspectives [ 2 , 25 , 26 ]. Furthermore, as the parent-team therapeutic alliance is posited to be crucial in promoting the outcomes of residential psychiatry, research is needed to the effect of strengthening the parent-team alliance in residential settings.…”