title: The role of setting versus treatment type in alliance within youth therapy.
abstract: OBJECTIVE
  Does the strength of the youth-therapist alliance differ across treatment settings or treatment type? We examined these questions in the context of youth therapy.
  
  
  METHODS
  Eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with an anxiety disorder received (a) manual-based individual cognitive-behavioral therapy (ICBT) in a research setting, (b) manual-based ICBT in practice settings, or (c) nonmanualized usual care (UC) in practice settings. Coders, using the Therapy Process Observational Coding System-Alliance scale, rated 865 sessions. Youth completed the Therapeutic Alliance Scale for Children at posttreatment.
  
  
  RESULTS
  Youth who received ICBT in a research setting had significantly higher observer-rated alliance than youth who received either therapy delivered in practice settings. In practice settings, youth who received ICBT had significantly stronger observer-rated alliance early in treatment than youth in UC, but this difference was not observed at the end of treatment. Similarly, youth-report alliance at posttreatment was significantly higher in ICBT in the research setting, and there was no difference between ICBT and UC delivered in practice settings. Alliance differences largely held when controlling for youth characteristics; however, differences early in treatment between the ICBT groups were no longer statistically significant when controlling for anxiety severity or primary anxiety diagnosis.
  
  
  CONCLUSIONS
  Our findings suggest that (a) the alliance may be stronger in research settings, and (b) treatment manuals do not undermine alliance. Future research is required to help pinpoint whether other youth, therapist, or setting factors contribute to the lower alliance seen in practice settings.
authors.affiliation: Department of Psychology, Virginia Commonwealth University.
authors.forename: Bryce D
authors.initials: BD
authors.lastname: McLeod
authors.affiliation: Department of Psychology, University of Miami.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jensen-Doss
authors.affiliation: Department of Psychology, Virginia Commonwealth University.
authors.forename: Carrie B
authors.initials: CB
authors.lastname: Tully
authors.affiliation: Department of Psychology, Virginia Commonwealth University.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Southam-Gerow
authors.affiliation: Department of Psychology, Harvard University.
authors.forename: John R
authors.initials: JR
authors.lastname: Weisz
authors.affiliation: Department of Psychology, Temple University.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Kendall
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003299:Cooperative Behavior; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D011615:Psychotherapy, Group