We report a study of parents' attachment orientations and children's autobiographical memory for an experience that according to Bowlby's (1982) attachment theory should be particularly threatening-children's forced separation from their parents. It was hypothesized that individual differences in parents' attachment orientations would be associated with children's distress and memory for this highly traumatic event. Children (n = 28) were observed during forced removal from home or school by Child Protective Services due to allegations of child maltreatment. Children's memory for the removal was tested 1 week later, and biological parents (n = 28) completed an adult attachment measure. Parental attachment anxiety significantly predicted children's distress during less stressful phases of the removal, R(2) = .25, and parents' attachment-related avoidance predicted fewer correct memory reports from the children (i.e., fewer hits to open-ended questions, R(2) = .16, and fewer hits to direct questions, R(2) = .27). The findings indicate that attachment theory provides important guidance for understanding children's autobiographical memory for traumatic events.

Objective: Trauma-focused cognitive-behavioral therapy (TF-CBT) is a recommended treatment for posttraumatic stress (PTS) in youth, and a strong therapeutic alliance predicts reductions of PTS in TF-CBT. However, little is known of how therapists can build a strong alliance. This study seeks to understand which therapist behaviors are associated with the strength of alliance in TF-CBT. Method: Participants were 65 youth (M age ϭ 15.1, SD ϭ 2.19; 77% girls) engaged in TF-CBT and their therapists (n ϭ 24). The alliance was assessed midtreatment using the Therapeutic Alliance Scale for Children-revised. Therapists' behaviors were coded using the Adolescent Alliance-Building Scale-revised, and youth engagement behavior was coded using the Behavioral Index of Disengagement Scale. Linear mixed-effects models were used to evaluate clients' and therapists' in-session behaviors as predictors of the alliance, in addition to assessing the potential moderating effects of youth behaviors. Results: Rapport-building behaviors were significantly predictive of higher alliance scores (Est. ϭ 1.81, 95% CI [0.11, 3.52], p ϭ .038), whereas there was no predictive effect of treatment socialization or trauma-focusing behavior on alliance scores. Initial youth behavior significantly moderated the effect of trauma-focusing on the alliance (p ϭ .007); greater focus on trauma was associated with higher alliance scores among passively disengaged youth (Est. ϭ 4.92, 95% CI [1.80, 8.05], p ϭ .003). Conclusions: Rapport-building behaviors are associated with a stronger alliance in TF-CBT. Gradual exposure through initial trauma-eliciting does not appear to undermine alliance formation but is rather associated with higher alliance-scores among passively disengaged youth. What is the public health significance of this article?This study suggests that therapist rapport-building behaviors (i.e., focusing on youth's experiences, providing support, and cognitive restructuring) during the early phase of TF-CBT are associated with a stronger therapeutic alliance. Focusing on youth's traumatic experiences early in treatment does not undermine alliance building in TF-CBT. For youth who are marginally engaged when entering treatment, therapists' elicitation of trauma-related content seems to be beneficial for alliance formation.

No abstract

No abstract