title: The therapeutic alliance in treatment of traumatized youths: relation to outcome in a randomized clinical trial.
abstract: OBJECTIVE
  We examined the contribution of alliance to the outcome of therapy with traumatized youths across two different treatment conditions (trauma-focused cognitive behavioral therapy [TF-CBT] and therapy as usual [TAU]).
  
  
  METHODS
  Participants were 156 youths (M age = 15.1 years, range = 10-18; 79.5% girls), randomly assigned to TF-CBT or TAU. Symptoms were assessed pretreatment, midtreatment (Session 6), and posttreatment (Session 15). Alliance was assessed after Sessions 1 and 6, using the Therapeutic Alliance Scale for Children-Revised (TASC-R).
  
  
  RESULTS
  Alliance scores were comparable across treatment conditions, but TF-CBT participants had significantly lower posttraumatic stress symptoms (PTSS) posttreatment (d = 0.51). Hierarchical regression analyses showed that there were no significant alliance effects in models without an Alliance × Treatment Group interaction: Alliance ratings were significant predictors of reduction in PTSS (Est. = -0.53, p = .003, 95% confidence interval [CI] = -0.87 to -0.18) and additional outcomes measured in TF-CBT but not in TAU (PTSS posttreatment: Est. = 0.01, p = .647, 95% CI = -0.29 to 0.47).
  
  
  CONCLUSIONS
  This study was the first to investigate the contribution of alliance to outcome among adolescents with posttraumatic symptoms, treated with TF-CBT or TAU. Our findings indicated that there was an important interaction between alliance and therapeutic approach, as alliance predicted outcome in TF-CBT, but not in the nonspecific treatment condition. A positive working relationship appeared to be especially important in the context of this evidence-based treatment, which requires youth involvement in specific therapy tasks. Further, findings showed that use of a manual did not compromise alliance formation.
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies.
authors.forename: Silje M
authors.initials: SM
authors.lastname: Ormhaug
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies and Department of Psychology, University of Oslo.
authors.forename: Tine K
authors.initials: TK
authors.lastname: Jensen
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies.
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.affiliation: Department of Psychology, University of Denver.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Shirk
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome