Relationship Processes in Youth Psychotherapy

Abstract

This study explores hypothesized associations among therapist engagement strategies, therapeutic alliance, client involvement, and treatment outcome in a randomized clinical trial comparing cognitive behavioral psychotherapy and nondirective supportive psychotherapy for adolescents with depressive symptoms who have attempted suicide. Ratings from audiotapes and self-report of the first four sessions for 23 adolescent clients were used. It was expected that therapeutic relationship variables would be equally important in both treatments. However, preliminary evidence appeared to be emerging only for therapeutic alliance and client involvement being related to treatment outcome in the cognitive behavioral treatment. Therapist lapse behaviors were found to predict alliance across both treatments. On the other hand, there was some preliminary evidence for different therapist behaviors to be related to the therapeutic alliance in each treatment. Results suggest that there may be variation in effective relationship factors, depending on the specific therapeutic approach.

The Relationship Between Alliance and Client Involvement in CBT for Child Anxiety Disorders

“…Early alliance did not predict level of involvement; however, a positive change in the alliance predicted level of involvement. This finding is consistent with previous conceptual work (e.g., Chu et al, 2010; Shirk & Karver, 2006) and a previous study that established a positive relation between the alliance and involvement in CBT for children with depressive symptoms (Karver et al, 2008). Taken together, there is some evidence supporting the assertion that a strong alliance sets the stage for subsequent involvement in CBT.…”

“…Using observational measures to assess alliance and involvement, Karver et al (2008) found that alliance measured at session three was positively associated with involvement at session four. However, most studies have not focused on in-session client involvement.…”

The therapeutic alliance in the cognitive behavioral treatment of pediatric obsessive–compulsive disorder

“…For example, therapists can be trained to increase certain behaviors associated with strong alliances (e.g., therapist responsiveness; Russell, Shirk, & Jungbluth, 2008) as well as decrease other behaviors associated with weak alliances (e.g., pushing the child to talk; Creed & Kendall, 2005;Karver et al, 2008). Thus, findings suggest that it remains crucial for therapists to continue to focus on the development of the TA while simultaneously attending to specific therapeutic tasks, such as exposure and response prevention.…”

How do therapists ally with adolescents in family therapy? An examination of relational control communication in early sessions.

“…Past research indicates the value of assessing adolescents' subjective experiences of the therapeutic relationship (Karver et al, 2008). Therefore, we recommend including self-report measures of the alliance in future investigations.…”