Predictors and outcomes associated with therapeutic alliance in cognitive behaviour therapy for children with autism

Abstract

Therapeutic alliance is often an important aspect of psychotherapy, though it is rarely examined in clients with autism. This study aims to determine the child pre-treatment variables and treatment outcomes associated with early and late alliance in cognitive behaviour therapy targeting emotion regulation for children with autism. Data were collected from 48 children with autism who participated in a larger randomized-controlled trial. Pre-treatment child characteristics included child, parent, and clinician report of child emotional and behavioural functioning. Primary outcome measures included child and parent-reported emotion regulation. Therapeutic alliance (bond and task-collaboration) was measured using observational coding of early and late therapy sessions. Pre-treatment levels of child-reported emotion inhibition were associated with subsequent early and late bond. Pre-treatment levels of parent and child-reported emotion regulation were related to early and late task-collaboration. Late task-collaboration was also associated with pre-treatment levels of behavioural and emotional symptom severity. Task-collaboration in later sessions predicted improvements in parent-reported emotion regulation from pre- to post-therapy. Future research is needed to further examine the role of task-collaboration as a mechanism of treatment change in therapies for children with autism.

Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges

“… Anderson et al (2012) recruited through public media campaigns and requests to health professionals. Albaum et al (2020) did not explicitly state the site of recruitment but stated that the study subjects were part of a larger RCT. Other studies recruited subjects that were referred by school personnel through the invitation to schools and the public ( Whitehead et al, 2019 ) or by referrals from schools ( Labouliere et al, 2017 ).…”

“…The Valadez-Sanchez study had four female participants ( Valadez-Sanchez, 2017 ). Male participants were 91.7% of the study participants in the study on ADHD ( Albaum et al, 2020 ).…”

“… Anderson et al (2012) randomised participants to individual CBT and internet-based CBT. Internet-based CBT ( Stjerneklar et al, 2019 ), Multimodal CBT-( Klebanoff et al, 2019 ), Trauma focused CBT- ( Zorzella et al, 2015 , 2017 ; Valadez-Sanchez, 2017 ; Kirsch et al, 2018 ; Loos et al, 2020 ), and Emotion regulation focused CBT was used by Albaum et al (2020) .…”

“…Child-therapist alliance was a significant predictor of post-treatment anxiety scores, and the parent-therapist alliance was only a marginally significant predictor ( Klebanoff et al, 2019 ). In autism spectrum disorder (ASD), the intelligence quotient of the child positively affected task collaboration late in therapy and was directly related to emotional regulation, child emotional lability, externalising symptoms, and therapist rated the severity of Autism, which predicted emotion regulation ( Albaum et al, 2020 ).…”

“…One was with autism spectrum disorder (ASD) and anxiety and the other cohort with anxiety only. The study sought to compare the strength of therapeutic alliance in each, utilising the intervention of Multimodal Cognitive Behavioural Therapy (MCBT; Klebanoff et al, 2019) while (Albaum et al, 2020) aimed to study if the therapeutic alliance was significantly predicted by pre-treatment symptomatology and whether early or late therapeutic alliance Exclude studies conducted in Adult cohort and studies using Group CBT as intervention, as stated in abstracts of studies…”