The therapeutic alliance in treatment of traumatized youths: Relation to outcome in a randomized clinical trial.

Ormhaug, Silje Mørup; Jensen, Tine K.; Wentzel‐Larsen, Tore; Shirk, Stephen R.

doi:10.1037/a0033884

Cited by 86 publications

(72 citation statements)

References 161 publications

(350 reference statements)

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“…It also should be noted that the changes in therapeutic alliance across sessions are relatively small in magnitude; however, these changes are comparable to alliance changes reported in other studies (i.e., Kazdin et al, 2006; Ormhaug, Jensen, Wentzel-Larsen, & Shirk, 2014), suggesting that therapeutic alliance may be fairly stable over the course of therapy. Furthermore, even studies that have found relatively small mean changes in alliance over time across entire samples have found these changes to be clinically meaningful, in that they predict symptom change (Bickman et al, 2012).…”

Section: Discussionsupporting

confidence: 74%

Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement

Labouliere

Reyes

Shirk

et al. 2015

Journal of Clinical Child & Adolescent Psychology

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Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth literature; however, past research frequently suffered measurement issues that obscured temporal relationships between alliance and symptomatology by measuring variables later in therapy, thereby precluding examination of important early changes. The current study aimed to explore the directions of effect between alliance and outcome early in therapy with adolescents by examining associations between first- and fourth-session therapeutic alliance and symptomatology. Thirty-four adolescents (~63% female, 38% ethnic/racial minority) participated in a school-based cognitive-behavioral therapy for adolescents with depression. Participants completed the Beck Depression Inventory at baseline and Session 4, and therapeutic alliance was coded from audiotapes of Sessions 1 and 4 by objective coders using the Alliance Observation Coding System. Autoregressive path analyses determined that first-session therapeutic alliance was a strong significant predictor of Session 4 depression symptoms, but pretreatment depression scores were not significantly predictive of subsequent therapeutic alliance. Adding reciprocal effects between alliance and depression scores did not adversely affect model fit, suggesting that reciprocal effects may exist. Early therapeutic alliance with adolescents is critical to fostering early gains in depressive symptomatology. Knowing alliance’s subsequent effect on youth outcomes, clinicians should increase effort to foster a strong relationship in early sessions and additional research should be conducted on the reciprocal effects of therapeutic alliance and treatment outcome in adolescence.

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Section: Discussionsupporting

confidence: 74%

Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement

Labouliere

Reyes

Shirk

et al. 2015

Journal of Clinical Child & Adolescent Psychology

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“…On balance, parents in TF-CBT spent more time with the therapist and likely more time reviewing parenting skills with the therapist than did parents/caregivers in Step One. A recent study found that therapeutic alliance was a significant predictor of child outcome for TF-CBT but not for nonspecific psychotherapy (Ormhaug et al 2014). It would be interesting to study the role of therapeutic alliance in parent-led treatment versus therapist-led treatment, and to explore if there are other differentiating mechanisms of change between the two service delivery approaches.…”

Section: Discussionmentioning

confidence: 99%

Parents’ Perception of Stepped Care and Standard Care Trauma-Focused Cognitive Behavioral Therapy for Young Children

et al. 2015

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Delivery systems other than in-office therapist-led treatments are needed to address treatment barriers such as accessibility, efficiency, costs, and parents wanting an active role in helping their child. To address these barriers, stepped care trauma focused-cognitive behavioral therapy (SC-TF-CBT) was developed as a parent-led, therapist-assisted therapy that occurs primarily at-home so that fewer in-office sessions are required. The current study examines caregivers’ perceptions of parent-led (SC-TF-CBT) and therapist-led (TF-CBT) treatment. Participants consisted of 52 parents/care-givers (25–68 years) of young trauma-exposed children (3–7 years) who were randomly assigned to SC-TF-CBT (n = 34) or to TF-CBT (n = 18). Data were collected at mid-and post-treatment via interviews inquiring about what participants liked, disliked, found most helpful, and found least helpful about the treatment. Results indicated that parents/caregivers favored relaxation skills, affect modulation and expression skills, the trauma narrative, and parenting skills across both conditions. The majority of parents/caregivers in SC-TF-CBT favored the at-home parent–child meetings and the workbook that guides the parent-led treatment, and there were suggestions for improving the workbook. Reported disliked and least helpful aspects of treatments were minimal across conditions, but themes that emerged that will need further exploration included the content and structure, and implementation difficulties for both conditions. Collectively, these results highlight the positive impact that a parent-led, therapist-assisted treatment could have in terms of providing caregivers with more tools to help their child after trauma and reduce barriers to treatment.

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“…This way, OT could potentially enhance motivation for treatment, as well as the therapeutic alliance (Olff et al, 2010). Strength of therapeutic alliance, defined as the affective bond between the therapist and patient, is an important and consistent predictor of treatment success (Ormhaug et al, 2014) and depends on the patient's attachment security: more secure attachment is related to stronger therapeutic alliance and vice-versa (see Diener and Monroe, 2011 for a metaanalysis). Attachment style may be particularly relevant in PTSD: insecure attachment, has been associated with higher PTSD symptom severity in trauma-exposed individuals (see Woodhouse et al, 2015 a meta-analysis).…”

Section: Discussionmentioning

confidence: 99%

Intranasal Oxytocin Administration Dampens Amygdala Reactivity towards Emotional Faces in Male and Female PTSD Patients

Koch

Zuiden

Nawijn

et al. 2015

Neuropsychopharmacol

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Post-traumatic stress disorder (PTSD) is a disabling psychiatric disorder. As a substantial part of PTSD patients responds poorly to currently available psychotherapies, pharmacological interventions boosting treatment response are needed. Because of its anxiolytic and pro-social properties, the neuropeptide oxytocin (OT) has been proposed as promising strategy for treatment augmentation in PTSD. As a first step to investigate the therapeutic potential of OT in PTSD, we conducted a double-blind, placebo-controlled, cross-over functional MRI study examining OT administration effects (40 IU) on amygdala reactivity toward emotional faces in unmedicated male and female police officers with (n = 37, 21 males) and without (n = 40, 20 males) PTSD. Trauma-exposed controls were matched to PTSD patients based on age, sex, years of service and educational level. Under placebo, the expected valence-dependent amygdala reactivity (ie, greater activity toward fearful-angry faces compared with happy-neutral faces) was absent in PTSD patients. OT administration dampened amygdala reactivity toward all emotional faces in male and female PTSD patients, but enhanced amygdala reactivity in healthy male and female traumaexposed controls, independent of sex and stimulus valence. In PTSD patients, greater anxiety prior to scanning and amygdala reactivity during the placebo session were associated with greater reduction of amygdala reactivity after OT administration. Taken together, our results indicate presumably beneficial neurobiological effects of OT administration in male and female PTSD patients. Future studies should investigate OT administration in clinical settings to fully appreciate its therapeutic potential.

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The therapeutic alliance in treatment of traumatized youths: Relation to outcome in a randomized clinical trial.

Cited by 86 publications

References 161 publications

Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement

Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement

Parents’ Perception of Stepped Care and Standard Care Trauma-Focused Cognitive Behavioral Therapy for Young Children

Intranasal Oxytocin Administration Dampens Amygdala Reactivity towards Emotional Faces in Male and Female PTSD Patients

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