title: Simulation modeling analysis of sequential relations among therapeutic alliance, symptoms, and adherence to child-centered play therapy between a child with autism spectrum disorder and two therapists.
abstract: This study examined the sequential relations among three pertinent variables in child psychotherapy: therapeutic alliance (TA) (including ruptures and repairs), autism symptoms, and adherence to child-centered play therapy (CCPT) process. A 2-year CCPT of a 6-year-old Caucasian boy diagnosed with autism spectrum disorder was conducted weekly with two doctoral-student therapists, working consecutively for 1 year each, in a university-based community mental-health clinic. Sessions were video-recorded and coded using the Child Psychotherapy Process Q-Set (CPQ), a measure of the TA, and an autism symptom measure. Sequential relations among these variables were examined using simulation modeling analysis (SMA). In Therapist 1's treatment, unexpectedly, autism symptoms decreased three sessions after a rupture occurred in the therapeutic dyad. In Therapist 2's treatment, adherence to CCPT process increased 2 weeks after a repair occurred in the therapeutic dyad. The TA decreased 1 week after autism symptoms increased. Finally, adherence to CCPT process decreased 1 week after autism symptoms increased. The authors concluded that (1) sequential relations differ by therapist even though the child remains constant, (2) therapeutic ruptures can have an unexpected effect on autism symptoms, and (3) changes in autism symptoms can precede as well as follow changes in process variables.
authors.affiliation: 1 Long Island University, Brookville, New York, USA.
authors.forename: Geoff
authors.initials: G
authors.lastname: Goodman
authors.affiliation: 2 Chungnam National University, Daejeon, South Korea.
authors.forename: Hyewon
authors.initials: H
authors.lastname: Chung
authors.affiliation: 1 Long Island University, Brookville, New York, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Fischel
authors.affiliation: 1 Long Island University, Brookville, New York, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Athey-Lloyd
mesh_terms: D000067877:Autism Spectrum Disorder / Q000523:psychology / Q000628:therapy*; D002648:Child; D006801:Humans; D008297:Male; D008960:Models, Psychological; D010989:Play Therapy / Q000379:methods*; D011369:Professional-Patient Relations
keywords: Child-centered play therapy; autism spectrum disorder; simulation modeling analysis; therapeutic alliance; treatment outcomes