Client-therapist alliance discrepancies and outcome in cognitive-behavioral therapy for youth anxiety.
BACKGROUND
Studies exploring the association between alliance and outcome in youth cognitive-behavioral therapy (CBT) have yielded inconsistent results based upon whose perspective is measured.


OBJECTIVE
The current study explored the degree to which youth with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, anxiety disorders and their therapists agree in their ratings of the alliance at multiple assessment points and evaluated whether inter-rater discrepancies predicted treatment outcome.


METHODS
Youth (N = 62; Mage = 12.43, SD = .76) received empirically supported CBT. Paired samples t tests assessed for significant disagreement between youth- and therapist-rated alliance at sessions 4, 8, and 12. Regression analyses were conducted to evaluate whether discrepancies between raters at each time point predicted posttreatment anxiety symptom scores.


RESULTS
Overall, alliance was positive for both child (aged 7-12 years) and adolescent (aged 13-16 years) clients. Discrepancies between youth and therapist ratings of alliance were statistically significant at session 4 for children and session 8 for adolescents, with youth rating the relationship more favorably than therapists. However, rating discrepancies did not predict youth- or parent-reported treatment outcome.


CONCLUSIONS
Considerable variability may exist between youth and therapist perspectives on the therapeutic alliance, indicating potential attunement problems, particularly during earlier phases of treatment. However, these discrepancies did not negatively affect treatment response. Implications for alliance research and clinical practice are discussed.
University of Pennsylvania, Department of Psychiatry.
Laurie J
LJ
Zandberg
Laura C
LC
Skriner
Brian C
BC
Chu
D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D001294:Attitude to Health; D002648:Child; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D000297:Psychology, Adolescent; D012044:Regression Analysis; D015203:Reproducibility of Results; D016896:Treatment Outcome
alliance; child and adolescent anxiety; cognitive-behavioral therapy; treatment outcome