Interpersonal predictors of early therapeutic alliance in a transdiagnostic cognitive-behavioral treatment for adolescents with anxiety and depression.

Abstract

The importance of therapeutic alliance in predicting treatment success is well established, but less is known about client characteristics that predict alliance. This study examined alliance predictors in adolescents with anxiety and/or depressive disorders (n=31) who received a transdiagnostic cognitive-behavioral treatment, the Unified Protocol for the Treatment of Emotional Disorders in Youth (Ehrenreich, Buzzella, Trosper, Bennett, & Barlow, 2008) in the context of a larger randomized controlled trial. Alliance was assessed at session three by therapists, clients, and independent observers. Results indicated that alliance ratings across the three informant perspectives were significantly associated with one another, but that pretreatment interpersonal variables (e.g., social support, attachment security, and social functioning in current family and peer relationships) were differentially associated with varying informant perspectives. Adolescent and observer ratings of alliance were both predicted by adolescent self-reports on measures reflecting how they perceive their interpersonal relationships. In addition, adolescent-reported symptom severity at pretreatment predicted observer ratings of alliance such that adolescents who indicated greater anxiety and depressive symptoms were rated as having stronger early alliances by independent observers. Therapists perceived having weaker early alliances with adolescents evidencing clinically significant depression at intake as compared with adolescents diagnosed with anxiety disorders alone. Future research is needed to examine whether identification of relevant interpersonal factors at intake can help improve initial therapeutic engagement and resulting outcomes for the psychosocial treatment of adolescents with anxiety and depressive disorders.

Child social and emotion functioning as predictors of therapeutic alliance in cognitive–behavioral therapy for anxiety

“…Despite Levin et al. () study, the remaining literature examining social competence in relation to alliance has linked both positive (e.g., social support) and negative (e.g., hostility) social constructs to alliance. However, these studies included different age ranges, such as adults, and/or different presenting problems, such as oppositional behaviors.…”

“…This notion is partly supported in the extant literature. For instance, in the one study that included anxious (and depressed) youth, relationship quality with a caregiver and perceived social support was related to stronger therapeutic alliance during a cognitive–behavioral treatment (Levin et al., ). However, adolescents’ perceptions of their own social competence in relationships were not related to alliance (Levin et al., ).…”

“…Only one study has examined social functioning in anxious youth in relation to alliance. Levin, Hendersen, and Ehrenreich‐May () found that adolescent‐reported perceived social support from friends and family accounted for 26% of the variance in observer‐ratings of alliance. However, none of the measures of social functioning related to therapists’ ratings of alliance.…”

Counseling Canadian Indigenous Peoples: The Therapeutic Alliance and Outcome

“…For instance, Orlinsky et al () reported over 1,000 research findings that show an association between therapeutic alliance and client outcomes. Also, research findings have demonstrated that the therapeutic alliance early in the treatment process is a stronger predictor of counseling outcomes than the alliance later in the treatment process (Hersoug, Monsen, Havik, & Høglend, ; Levin, Henderson, & Ehrenreich‐May, ). Based on numerous studies and meta‐analyses, researchers have reported that the client's view of the alliance is typically a better predictor of outcome than the counselor's view (Bachelor & Horvath, ; Castonguay, Constantino, & Holtforth, ; Horvath & Bedi, ; Horvath & Symonds, ).…”

Patterns of therapeutic alliance: Rupture–repair episodes in prolonged exposure for posttraumatic stress disorder.

“…Given that alliance is considered an important component of client engagement and better treatment outcome (e.g., Gaston, 1991), the co-occurrence of MDD with PTSD may potentially hinder clients’ motivation for forming a strong relationship with their therapist and fully engaging in the treatment. Finally, recent evidence suggests that therapists report a weaker alliance with patients who present with anxiety and co-occurring depression than with individuals who present with anxiety alone (Constantino & Smith-Hansen, 2008; Levin, Henderson, Ehrenrich-May, 2012). …”