Therapeutic alliance as a predictor of behavioral outcomes in a relationally focused, family‐centered telehealth intervention

Abstract

This study evaluates therapeutic alliance as a mediator of the relationship between dosage and clinical outcomes for the Family Check‐Up (FCU) Online, a telehealth adaptation of an evidence‐based parenting intervention for parents of middle school youth. The sample consisted of N = 111 parents with children in middle school who received the FCU Online as part of an ongoing clinical trial. They were randomly assigned to receive telehealth coaching and participated in the intervention and follow‐up assessment 12 months later. Data was collected using parent and child questionnaires as well as engagement data collected as part of the online intervention, using both parents and children as reporters of parent behavioral change. Using parent report measures, there was clear support for a mediation model, with parent report of alliance predicting parent self‐report ratings of clinical progress (parent behavior change) at 12‐month follow‐up. However, for the child‐report data, there was no clear relationship between dosage or therapeutic alliance with child reports of parenting. Clinical implications and future research directions are discussed.

How therapists respond to “uneven” alliances in couple and family therapy: A conversation‐analytic study

“…This finding is in line with research demonstrating that normative assumptions are performed in the context of professional practice (Pawelczyk et al, 2021; Sutherland et al, 2016). We assume that when exclusive identification colonizes the therapist's perception of given interactional episodes of asymmetry, they do not recognize the necessity of collaborating with the entire system as posited by Metcalfe et al (2021) and Whittaker et al (2022). Moreover, therapists may also overlook the risk of compromising multiple alliances as postulated by Friedlander et al (2018) and Friedlander et al (2022).…”

“…The importance of developing and maintaining such multidimensional alliances has been robustly discussed in family and couple therapy research (e.g., Friedlander et al, 2018Friedlander et al, , 2022Rait, 2000). Recent studies point to the necessity of parallel collaboration with the entire family and couple system while building therapeutic alliances (Metcalfe et al, 2021;Whittaker et al, 2022). Therefore, investigating how this complex work is done interactively, that is how the alliance is discursively and interactionally accomplished was undertaken by interactional research (e.g., Horvath & Muntigl, 2018;Muntigl & Horvath, 2016;Sutherland & Strong, 2011).…”

Engaging Preschool and Early Elementary School-Aged Children in Exposure and Response Prevention (ERP)

“…Of course, this varies depending on the specific child and family. Flexibility in the delivery of evidence-based care, based on the child's needs and families' unique circumstances, is important and, when combined with other "common factors" such as empathy and a therapeutic alliance with parent and child, can improve treatment (Franklin et al, 2019;Metcalfe et al, 2021).…”

“…To optimize the effectiveness of treating children, attending to the therapeutic alliance should be a specific early focus of treatment. Establishing strong provider-child and provider-parent relationships are the foundation upon which both children and parents are motivated to engage in, and support, challenging and difficult behavior changes (e.g., Metcalfe et al, 2021). Children should enjoy attending sessions and voluntarily return each week.…”

Efficacy of intensive CBT telehealth for obsessive-compulsive disorder during the COVID-19 pandemic

“…Notably, dosage in remote treatment is often nebulous and can involve more than one factor (e.g., time with therapist, number of sessions, number of minutes using an online service). For example, Metcalfe, Matulis, Cheng, and Stormshak (2021) defined dosage using both minutes engaging with a therapeutic coach and minutes engaging with an online intervention without a therapist coach.…”