The broad goal of the proposed research is to examine child-therapist and caregiver-therapist alliance in families receiving community mental health services. Therapeutic alliance is an issue of paramount importance to clinicians and clients, and it is associated with outcomes in adult and child psychotherapy research. While over 2000 studies have examined the client-therapist alliance within the context of adult psychotherapy, very few studies have examined alliance within the context of child or family psychotherapy, and even fewer have investigated alliance in usual care child psychotherapy. Since little is known about the temporal stability of alliance or concordance of multiple perspectives on alliance, the proposed study will first address the complexities of measuring alliance across time and informants. Furthermore, this study will examine the association between alliance and therapeutic change in the child, caregiver, and family (i.e., whose alliance, according to whom, is most strongly associated with which outcomes). Finally, if significant alliance-outcome associations are found, therapist characteristics and behaviors associated with alliance will be explored. This last aim may generate hypotheses about therapist behaviors that could be changed to impact alliance;thus, it has significant implications for informing practice and improving care. The representative sample includes 219 children with disruptive behavior problems receiving usual care. Therapeutic alliance and various outcomes will be assessed throughout the course of psychotherapy, up to 16 months after initiating psychotherapy. In addition, coded videotapes of psychotherapy sessions will provide information about therapist behaviors that might impact therapeutic alliance strength. Coded videotapes also allow for an additional perspective (i.e., observer report) on child-therapist and caregiver/therapist alliance.
The proposed study examines an issue of great clinical relevance and utility within the context of usual care child psychotherapy. It addresses several methodological questions that have not been well-studied in the child psychotherapy alliance literature, and it further contributes to current knowledge about alliance outcome associations. This research has the potential to help bridge the research-practice gap because of its strong ecological validity and attention to issues of great clinical relevance and utility. Better understanding of therapeutic alliance in community mental health services is valuable because it will ultimately inform improvements in care for children.
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