title: Attachment history as a moderator of the alliance outcome relationship in adolescents.
abstract: The role of the alliance in predicting treatment outcome is robust and long established. However, much less attention has been paid to mechanisms of change, including moderators, particularly for youth. This study examined the moderating role of pretreatment adolescent-caregiver attachment and its impact on the working alliance-treatment outcome relationship. One hundred adolescents and young adults with primary substance dependence disorders were treated at a residential facility, with a cognitive-behavioral emphasis. The working alliance and clinical symptoms were measured at regular intervals throughout treatment. A moderator hypothesis was tested using a path analytic approach. Findings suggested that attachment to the primary caregiver moderated the impact of the working alliance on treatment outcome, such that for youth with the poorest attachment history, working alliance had a stronger relationship with outcome. Conversely, for those with the strongest attachment histories, alliance was not a significant predictor of symptom reduction. This finding may help elucidate alliance-related mechanisms of change, lending support for theories of corrective emotional experience as one function of the working alliance in youth psychotherapy.
authors.affiliation: Department of Psychiatry, Stanford University Medical Center.
authors.forename: Sanno E
authors.initials: SE
authors.lastname: Zack
authors.affiliation: Department of Psychology, The Pennsylvania State University.
authors.forename: Louis G
authors.initials: LG
authors.lastname: Castonguay
authors.affiliation: Department of Psychology, University at Albany, SUNY.
authors.forename: James F
authors.initials: JF
authors.lastname: Boswell
authors.affiliation: Department of Psychology, The Pennsylvania State University.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: McAleavey
authors.affiliation: Sundown Ranch, Inc.
authors.forename: Robert
authors.initials: R
authors.lastname: Adelman
authors.affiliation: Outcome Referrals, Inc.
authors.forename: David R
authors.initials: DR
authors.lastname: Kraus
authors.affiliation: Capella University.
authors.forename: George A
authors.initials: GA
authors.lastname: Pate
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D011369:Professional-Patient Relations; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult