title: Observer, youth, and therapist perspectives on the alliance in cognitive behavioral treatment for youth anxiety.
abstract: This study examined the score reliability and validity of observer- (Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale [TPOCS-A]; Vanderbilt Therapeutic Alliance Scale Revised, Short Form [VTAS-R-SF]), therapist- (Therapeutic Alliance Scale for Children Therapist Version [TASC-T]), and youth-rated (Therapeutic Alliance Scale for Children Child Version [TASC-C]) alliance instruments. Youths (N = 50) aged 7-15 (Mage = 10.28 years, SD = 1.84; 88.0% Caucasian; 60.0% male) diagnosed with a principal anxiety disorder received manual-based cognitive-behavioral treatment. Four independent coders, 2 using the TPOCS-A and 2 using the VTAS-R-SF, rated 2 sessions per case from early (Session 3) and late (Sessions 12) treatment. Youth and therapists completed the TASC-C and TASC-T at the end Session 3 and 12. Internal consistency of the alliance instruments was α > .80 and interrater reliability of the observer-rated instruments was ICC(2,2) > .75. The TPOCS-A, VTAS-R-SF, and TASC-T scores showed evidence of convergent validity. Conversely, the TASC-C scores failed to converge with the other instruments in a sample of children (age <11), but did converge in a sample of adolescents (age ≥11). Findings supported the predictive validity of the TASC-T and TASC-C scores. However, whereas the direction of the alliance-outcome association for both observer-rated instruments was in the expected direction for children (negative), the correlations were in the opposite direction for adolescents (positive). Overall, findings support the score reliability of observer- and therapist-report alliance instruments, but questions are raised about the score validity for the observer- and youth-report alliance instruments. (PsycINFO Database Record
authors.affiliation: Department of Psychology, Virginia Commonwealth University.
authors.forename: Bryce D
authors.identifier: 0000-0002-0996-0492
authors.initials: BD
authors.lastname: McLeod
authors.affiliation: Department of Psychology, Virginia Commonwealth University.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Southam-Gerow
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; D001291:Attitude of Health Personnel; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011594:Psychometrics / Q000706:statistics & numerical data*