Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review.

Abstract

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered.

A Theoretical Model of Common Process Factors in Youth and Family Therapy

“…Surveys have shown that clinicians who provide mental health services to child and adolescent clients highly value the therapeutic relationship (Bickman et al, 2000). The metaanalysis by Shirk and Karver (2003) also showed that therapeutic relationship variables are predictive of youth treatment outcomes. Yet, little is known about how these therapeutic relationship variables contribute to positive treatment outcomes.…”

“…As Lambert and Barley (2002) noted, common process factors (i.e., relationship variables) reportedly account for 30% of the variance in adult treatment outcomes, above and beyond the 15% of variance accounted for by specific therapeutic techniques. Furthermore, empirical research suggests that one common factor, the therapeutic alliance, is among the most robust predictors of treatment outcomes for both adult and youth clients (Horvath & Bedi, 2002;Shirk & Karver, 2003). Recognizing the need for more research on common process factors, Division 29 of the American Psychological Association formed the Task Force on Empirically Supported Therapy Relationships to determine which relationship variables are evidencebased (Norcross, 2002).…”

“…It has been suggested that relationship variables may be equally, if not more, critical in youth and family therapy, as child and adolescent clients typically are not self-referred and often enter into treatment unaware of their problems, in conflict with their parents, and/or resistant to change (DiGiuseppe, Linscott, & Jilton, 1996;Shirk & Karver, 2003). It follows that developing a strong therapeutic relationship with young clients and/or their family members may reduce resistance to treatment and facilitate engagement by providing a stable, accepting and supportive context within which therapy may take place.…”

“…Indeed, preliminary evidence suggests that common process factors are significantly related to clinical outcomes for children and adolescents. Most notably, Shirk and Karver (2003) reported that elements of the therapeutic relationship were moderately strong predictors of treatment outcome in their meta-analysis of the youth mental health services literature.…”

“…4 Thus far, the common process factor research that has been done in the youth and family mental health treatment literature has not been systematic. Shirk and Karver's (2003) meta-analysis of this literature showed that almost every researcher was using a different measure of the therapeutic relationship. In addition, these studies did not appear to be driven by a cohesive theoretical model depicting the process by which elements of the therapeutic relationship contribute to clinical outcomes of youth.…”