The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists

Abstract

Through the perspectives of children, parents and therapists, this study explored the therapeutic relationship as a change facilitator in different moments of psychotherapy. The children, parents, and therapists (N=15) who formed part of five therapeutic treatments were studied using a qualitative, longitudinal design. Thirty semi-structured interviews were done; half at the beginning and half after four months of psychotherapy. Children’s drawings were incorporated, and data were analysed through grounded theory methods and qualitative analysis guidelines for drawings. Participants identified several aspects of the therapeutic relationship as change facilitators. From the first encounters, the therapists’ close and adaptable attitude promoted an improved motivation for psychotherapy and enhanced engagement among children and parents. Later in the process, a positive, child-centred and affective therapeutic relationship fostered the child’s trust with the therapist as well as a positive relational experience, promoting associated changes in children and the development of socio-affective tools. Parents and therapists saw their own relationship as a change facilitator, as well as a broader understanding in parents of their children and an improved relationship with them. Parent’s and child’s changes helped each other. Specific and common aspects between participants’ perspectives provided a richer understanding of the studied phenomena. This study supports the view that a positive therapeutic relationship facilitates early changes in the motivation of children and parents, and provides them with a healing, relational experience as it develops. A positive parent-therapist relationship is also key for changes to further progress.

The therapeutic relationship as a change mechanism in child psychotherapy: a qualitative study of children, parents’, and therapists’ views in different moments of the process (La relación terapéutica como un mecanismo de cambio en la psicoterapia infantil: un estudio cualitativo de las perspectivas de niño/as, padres, y terapeutas en diferentes momentos del proceso)

“…También advierten que sus madres tienen actitudes más cariñosas y menos hostiles con ellos (Capella et al, 2018). Los padres manifiestan que comprenden más los problemas del niño/a, y consiguen gestionar mejor sus dificultades (Alamo, 2019;Núñez et al, 2022).…”

“…They report a positive appreciation of their therapists and view them as someone who can help them, highlighting the trust and affection to their therapist, having fun and playing (Areas et al, 2020;Capella et al, 2018;Núñez et al, 2021). These interpersonal elements improve children's and parents' attitudes towards therapy (Alamo, 2019;Areas et al, 2020;Capella et al, 2018;Núñez et al, 2022).…”

“…The core findings of phases 1 and 2 were already published (Núñez et al, 2022(Núñez et al, , 2021, so the focus of the present paper is phase 3.…”

Systemic Therapeutic Alliance in the Context of Pediatric Interventions for Neurodevelopmental Disorders

“…In the context of pediatric interventions, the therapeutic alliance is not just confined within the child-therapist relationship but also with the child's immediate family, particularly with the parents [10,11]. It is the decision of parents to bring their child to therapy or seek other medical services.…”

Young people's experience of the therapeutic alliance: A systematic review

“…Therapists may have different approaches to overcoming these challenges. However, gaining greater knowledge of adolescent clients' experiences is considered crucial for the development of the therapeutic alliance and change in therapy, as clients are considered ‘the site of change’ or active participants in the therapeutic process (Elliott, 2008; Horvath et al, 2011; Karver et al, 2018; Nuñez et al, 2022). Recognising young people's active role in shaping the narrative of enabling and hindering factors in alliance formation may be one of the most important tasks of both researchers and clinicians (Gibson & Cartwright, 2014).…”