The Relationship Between Alliance and Client Involvement in CBT for Child Anxiety Disorders

Abstract

Objective Little is known about the nature of the relationship between the alliance and client involvement in child psychotherapy. To address this gap, we examined the relationship between these therapy processes over the course of cognitive-behavioral therapy (CBT) for child anxiety disorders. Method The sample was 31 child participants (Mage = 9.58 years, SD = 2.17, range 6–13 years, 67.7% boys; 67.7% Caucasian, 6.5% Latino, 3.2% Asian/Pacific Islander, and 22.6% mixed/other) diagnosed with a primary anxiety disorder. The participants received a manual-based individual CBT program for child anxiety or a manual-based family CBT program for child anxiety. Ratings of alliance and client involvement were collected on early (session two) and late (session eight) treatment phases. Two independent coding teams rated alliance and client involvement. Results Change in alliance positively predicted late client involvement after controlling for initial levels of client involvement. In addition, change in client involvement positively predicted late alliance after controlling for initial levels of the alliance. The findings were robust after controlling for potentially confounding variables. Conclusions In CBT for child anxiety disorders, change in the alliance appears to predict client involvement; however, client involvement also appears to predict the quality of the alliance. Our findings suggest that the nature of the relationship between alliance and client involvement may be more complex than previously hypothesized. In clinical practice, tracking alliance and level of client involvement could help optimize the impact and delivery of CBT for child anxiety.

Videoteleconferencing Early Child Anxiety Treatment: A Case Study of the Internet-Delivered PCIT CALM (I-CALM) Program

“…Moreover, given research suggesting working alliance and involvement can promote treatment engagement and symptom change within child anxiety treatment (Chu & Kendall, 2004; Marker, Comer, Abramova, & Kendall, 2013; McLeod et al, 2014), the very strong therapeutic alliance reported throughout this VTC treatment is encouraging. Although these findings are limited to the experiences of one family, similar patterns of therapeutic alliance and patient satisfaction have also been observed in larger trials of VTC-facilitated treatment conducted in adult populations ( see Simpson & Reid, 2014 for a review).…”

Feedback‐informed treatment and autonomy supportiveness: Effects on children s psychological outcomes

“…They also suggested a process, such as a feedback system, to allow clinicians to identify and proactively address alliance and involvement issues (Mcleod et al, 2014). These researchers suggested future work focus on indicators that present early in treatment such as therapist credibility and client motivation.…”

“…These researchers suggested future work focus on indicators that present early in treatment such as therapist credibility and client motivation. They also suggested a process, such as a feedback system, to allow clinicians to identify and proactively address alliance and involvement issues (Mcleod et al, 2014). Block and Greeno's (2011)…”

Using a Health Behavior Model to Inform Understanding of Therapy Engagement in Child Therapy: A Qualitative Study

“…Caregivers play a critical role in treatment attendance as they consent for children to participate in therapy and provide transportation (Shirk & Russell, 1998). For the children and families who attend therapy, low involvement in therapeutic activities can undermine the alliance and contribute to drop out (McLeod et al, 2014;Patterson & Chamberlain, 1994). Poor therapy engagement is thus a widespread problem in practice settings (McKay & Bannon, 2004).…”