Child involvement, alliance, and therapist flexibility: process variables in cognitive-behavioural therapy for anxiety disorders in childhood.
BACKGROUND
This study examined the relations between treatment process variables and child anxiety outcomes.


METHODS
Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6-14 yr-old; M = 10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up.


RESULTS
Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome.


CONCLUSIONS
Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters.
Macquarie University, Centre for Emotional Health, Department of Psychology, NSW 2109, Australia. Electronic address: jennie.hudson@mq.edu.au.
Jennifer L
JL
Hudson
Temple University, United States.
Philip C
PC
Kendall
Rutgers University, United States.
Brian C
BC
Chu
Philadelphia College of Osteopathic Medicine, United States.
Elizabeth
E
Gosch
National Institute of Mental Health, United States.
Erin
E
Martin
Macquarie University, Centre for Emotional Health, Department of Psychology, NSW 2109, Australia.
Alan
A
Taylor
Macquarie University, Centre for Emotional Health, Department of Psychology, NSW 2109, Australia.
Ashleigh
A
Knight
D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011369:Professional-Patient Relations; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Alliance; Child anxiety; Child involvement; Flexibility; Therapy process