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Therapeutic alliance has been considered an important factor in child psychotherapy and is consistently associated with positive outcomes. Nevertheless, research on alliance in the context of child trauma therapy is very scarce. This study examined the relationships between child therapeutic alliance and psychopathology in an empirically supported child trauma therapy model designed to address issues related to trauma with children and their caregivers. Specifically, we examined the extent to which the child's psychopathology would predict the establishment of a positive alliance early in treatment, as well as the association between alliance and outcome. Participants were 95 children between the ages of 7 and 12 and their caregivers, who went through a community-based Trauma-Focused Cognitive Behavioral Therapy program in Canada. Caregivers filled out the CBCL prior to assessment and following treatment. Children and therapists completed an alliance measure (TASC) at three time points throughout treatment. Symptomatology and child gender emerged as important factors predicting alliance at the beginning of treatment. Girls and internalizing children developed stronger alliances early in treatment. In addition, a strong early alliance emerged as a significant predictor of improvement in internalizing symptoms at the end of treatment. Our findings indicate that symptomatology and gender influence the development of a strong alliance in trauma therapy. We suggest that clinicians should adjust therapeutic style to better engage boys and highly externalizing children in the early stages of therapy.

Objective: Alexithymia is a personality trait that reflects deficits in the cognitive processing and regulation of emotions (Taylor & Bagby, 2013). It has been closely linked to childhood trauma and reported by individuals presenting with other trauma-related conditions, such as posttraumatic stress disorder (PTSD), dissociation, and interpersonal problems (Powers, Etkin, Gyurak, Bradley, & Jovanovic, 2015). Addressing the emotional deficits associated with alexithymia is fundamental to resolving issues of childhood trauma and, therefore, is at the core of many trauma therapy models (e.g., Cloitre, Koenen, Cohen, & Han, 2002). The current study aims to build upon this foundation by examining the role of alexithymia in the improvements of trauma-specific difficulties prior to and following trauma therapy among treatment-seeking women with histories of childhood abuse. Method: Data were collected from 167 participants attending Women Recovering from Abuse Program (WRAP), an 8-week, Stage I, day treatment program using primarily group therapy for women with histories of severe childhood trauma. Participants’ level of alexithymia, PTSD, and dissociative symptoms, and interpersonal difficulties were assessed at three time points. Results: Significant positive relationships were found between improvements in alexithymia and improvements on all trauma-specific outcomes over the course of treatment (e.g., baseline to posttreatment) and between distinct stages of WRAP. Conclusions: These findings underscore the role of alexithymia in trauma therapy, and the need to properly attend to the deficits and issues related to alexithymia at initial stages of therapy with survivors of childhood abuse in order to facilitate improvements in trauma-specific symptoms.

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Attachment has increasingly been identified as central to therapy process and outcome. Attachment theory proposes that an individual's prior interactions with attachment figures develop into templates that will guide the way they form connections and perceive their relationships with others. This study examined clients' ratings of their relationship with the therapist as well as their ratings of group climate at multiple discrete points during treatment. These variables were examined in relation to attachment classification prior to therapy. Participants were 62 women attending the Women Recovering from Abuse Program (WRAP), a primarily group-based day-treatment program for childhood interpersonal trauma, at Women's College Hospital in Toronto, Ontario, Canada. Results demonstrated that clients' perceptions of relationships in group therapy varied as a function of attachment classification.