Mapping the progress of the process: Codevelopment of the therapeutic alliance with maltreated adolescents.

Abstract

We used a longitudinal actor–partner interdependence model to examine the codeveloping alliance in alliance empowerment therapy (AET; Escudero, 2013), a manualized team-based approach developed in Spain specifically for child welfare-involved youth. In this first evaluation of AET, we sampled 102 adolescents, 83% of whom had been removed from their homes due to abuse or neglect, and 40% of whom were in crisis at the time of referral. Before each session, clients rated their improvement-so-far; after each session, both clients and therapists completed a brief alliance measure, an adaptation of the System for Observing Family Therapy Alliances (SOFTA-s; Friedlander et al., 2006) for individual therapy. In terms of outcome, clients’ improvement ratings were significantly associated with posttreatment changes in overall functioning and personal goal attainment. With respect to the change process, growth was observed in both clients’ and therapists’ ratings of the alliance over 12 sessions, and an increased similarity in alliance ratings was due to more rapid growth in the therapists’ ratings than the clients’ ratings. Dynamic structural equation modeling indicated that at higher levels of adolescent goal attainment, a stronger association was observed between increased therapist-rated alliance and goal attainment. In other words, in the most effective cases, therapists were more responsive to how the adolescents seemed to have experienced the alliance in the previous session. The cocreated alliance perceptions were due to therapist (rather than client) responsiveness, as well as to unspecified aspects of sharing a therapy environment over time, such as familiarity with the process, regular meetings, and so on.

Therapist and client perceptions of the working alliance: Codevelopment, linear growth, variability, and client functioning.

“…Attachment theory (Bowlby, 1988) highlights the importance of therapist responsiveness in building the working alliance and developing a secure attachment. Therefore, it is not surprising that therapist responsiveness was related to client improvement in Escudero et al’s (2022) study.…”

“…Escudero et al’s (2022) study suggested that different dynamics (actor and partner effects) are related to client outcome. The clients in Escudero et al’s (2022) study were adolescents who had recently been abused and neglected and the treatment specifically prioritized the working alliance as a corrective experience.…”

“…Escudero et al’s (2022) study suggested that different dynamics (actor and partner effects) are related to client outcome. The clients in Escudero et al’s (2022) study were adolescents who had recently been abused and neglected and the treatment specifically prioritized the working alliance as a corrective experience. Attachment theory (Bowlby, 1988) highlights the importance of therapist responsiveness in building the working alliance and developing a secure attachment.…”

“…For clients with better interpersonal functioning, the gradual strengthening and the repaired rupture patterns had greater improvement, whereas for clients with poorer interpersonal functioning, the early unrepaired rupture pattern showed better outcomes. Escudero et al (2022), in their examination of both linear growth in client and therapist working alliance and the codevelopment (see the section on codevelopment) of therapist and client working alliance, found that linear growth (increase) in therapist but not client working alliance was related to client improvement. The most consistent finding across the studies of the development of the working alliance is that linear growth in the alliance is related to client improvement.…”

“…As described by Escudero et al (2022), the therapeutic alliance develops because clients and therapists are responsive (change their perceptions and ratings of the working alliance) to shifts in each other’s attitudes and behavior from the last session. Specifically, therapists use their clients’ behaviors and expressions to infer the strength of their clients’ alliances, and carry this inference into the next session.…”