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Casari L, Areas M, Ison M, Gómez B, Roussos A, Consoli A, Gómez Penedo JM. Therapist's effect on children's therapeutic alliance: A naturalistic study. J Clin Psychol 2024; 80:207-222. [PMID: 37837638 DOI: 10.1002/jclp.23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/11/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA. METHODS The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q). RESULTS Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients). CONCLUSION We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.
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Affiliation(s)
- Leandro Casari
- INCIHUSA, CONICET, Mendoza, Argentina
- Facultad de Humanidades y Ciencias Económicas, Pontificia Universidad Católica Argentina, Mendoza, Argentina
| | - Malenka Areas
- CONICET, Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Andrés Roussos
- IPEHCS, Universidad del Comahue/ CONICET, Bariloche, Argentina
| | - Andrés Consoli
- University of California, Santa Barbara, California, USA
| | - Juan Martín Gómez Penedo
- CONICET, Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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Ryan R, Berry K, Hartley S. Review: Therapist factors and their impact on therapeutic alliance and outcomes in child and adolescent mental health - a systematic review. Child Adolesc Ment Health 2021; 28:195-211. [PMID: 34763371 DOI: 10.1111/camh.12518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young people's mental health is a significant concern globally. The evidence suggests that there is a strong relationship between therapeutic alliance and children's reported outcomes such as symptoms and dropout of services. There are indications that therapist characteristics - including static qualities and dynamic behaviours - can be associated with both alliance and outcomes. METHOD The aim of this review was to systematically collate, summarise and critique studies reporting on therapist characteristics that might influence the therapeutic alliance or outcomes for young people accessing child and adolescent mental health services. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed, and four databases (PsycINFO, PsycARTICLES, MEDLINE and CINAHL) were searched for 'therapist' and 'characteristic' combined with 'alliance' or 'outcome' and related terms associated with these topics. RESULTS A review of 15 papers showed that therapists' in-session behaviours and interpersonal style have a significant impact on alliance or outcome. One study also indicated important associations with attachment style. Findings related to ethnicity, gender and level of experience were complex; highlighting differences between subgroups, ages, outcome measurement and diagnostic categories. Methodological issues such as secondary analysis on administrative data confounded the interpretation of results. CONCLUSIONS There are indications that specific therapist factors can impact on alliance and outcomes in child and adolescent mental health services. Future research needs to adopt a prospective design and measure therapist characteristics and their relationship to alliance or outcome over time in a broad range of settings.
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Affiliation(s)
- Rachael Ryan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.,Pennine Care NHS Foundation Trust, Greater Manchester, UK
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Ryan R, Berry K, Law H, Hartley S. Therapeutic relationships in child and adolescent mental health services: A Delphi study with young people, carers and clinicians. Int J Ment Health Nurs 2021; 30:1010-1021. [PMID: 33764661 DOI: 10.1111/inm.12857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
Therapeutic relationships have been widely recognized as crucial to good outcomes in psychotherapy. However, there is comparatively little research on what constitutes and impacts therapeutic relationships in the context of child and adolescent mental health services (CAMHS). Relationships within CAMHS are inherently complex, with multiple relationships taking place between young people, parents or carers and staff members of various disciplines. The Delphi method was used to gain consensus regarding the definition of therapeutic relationships, what helps to build and what hinders the formation of a good relationship in the context of CAMHS. Three expert groups (young people, carers and staff) totalling 88 participants were invited to complete an online Delphi survey across three rounds. Consensus was reached to define the therapeutic relationship as trust, reliability and absence of judgemental attitudes (n = 19 statements). Factors that help build good relationships predominantly referred to staff behaviours of setting up open communication channels, showing acceptance of the young person's difficulties and being consistent (n = 88 consensus agreement statements). Factors that hindered a good relationship were inconsistencies and lack of clear communication between all groups (n = 18 consensus agreement statements). Effective therapeutic relationships require key behaviours and approaches from clinicians. It is essential that staff members are open and honest in facilitating discussions about parental involvement within the relationship and that staff provide consistent and trusting support to young people and family members. Our findings demonstrate that key stakeholders agree on important aspects and that these could be a catalyst for renewed training and support structures.
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Affiliation(s)
- Rachael Ryan
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health Foundation Trust, Manchester, UK
| | - Heather Law
- Greater Manchester Mental Health Foundation Trust, Manchester, UK
| | - Samantha Hartley
- School of Health Sciences, University of Manchester, Manchester, UK.,Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
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Rueda HA, Brown ML, Geiger JM. Technology and Dating Among Pregnant and Parenting Youth in Residential Foster Care: A Mixed Qualitative Approach Comparing Staff and Adolescent Perspectives. JOURNAL OF ADOLESCENT RESEARCH 2019. [DOI: 10.1177/0743558419861087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore the role of technology in the dating and sexual experiences of pregnant and parenting adolescent girls placed in residential foster care. Interviews with program staff ( N = 12; 50% Hispanic) and focus groups with adolescent foster youth ( N = 13; 46% Hispanic) were conducted to understand how technologies (e.g., cell phone, texting, and social media) influence youth’s dating lives, including how youth navigate conflict with a dating partner in technology spaces and their experiences with cyber abuse. Both staff and youth emphasized technology as providing an outlet from the home and forum through which to meet, interact, and sustain intimate relationships, the latter including the father of (a) child(ren). Youth creatively collaborated to access technology and became involved in each other’s relationships. Staff and youth discussed divergent risk contexts, staff emphasizing the risks posed to children (e.g., taken on online dates) and youth discussing online sexual solicitations, conflict with the child(ren)’s father in public and peer-involved online spaces, and cyber abuse. Helping professionals should be trained on the centrality of technology to youth dating and provide dating health education that includes attention to technology mediums.
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Duppong Hurley K, Van Ryzin MJ, Lambert M, Stevens AL. Examining Change in Therapeutic Alliance to Predict Youth Mental Health Outcomes. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2015; 23:90-100. [PMID: 25960629 PMCID: PMC4422506 DOI: 10.1177/1063426614541700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To examine the link between therapeutic alliance and youth outcomes. METHOD The study was conducted at a group-home with 112 youth with a disruptive-behavior diagnosis. Therapeutic alliance was collected routinely via youth and staff report. Outcome data were collected using youth and staff reports of externalizing behavior as well as behavioral incidents occurring during care. Outcome data were collected following intake into services and at 6 and 12 months of care. Data were analyzed to examine (1) if youth behavior problems at intake were predictive of therapeutic alliance and (2) if changes in alliance were predictive of subsequent youth outcomes. These were conducted with a 6-month service-delivery model and replicated with a 12-month model. RESULTS There was some support for the first hypothesis, that initial levels of youth externalizing behavior would be related to alliance ratings; however, most of the effects were marginally significant. The second hypothesis, that changes in therapeutic alliance would be related to subsequent youth outcomes, was supported for the 6-month model, but not the 12-month model. CONCLUSIONS Changes in therapeutic alliance may be predictive of youth outcomes during care. Additional research into examining therapeutic alliance trajectories is warranted to improve mental health services for youth.
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Affiliation(s)
- Kristin Duppong Hurley
- University of Nebraska-Lincoln, 247 Barkley Memorial Center, University of Nebraska-Lincoln, Lincoln, NE 68583-0732,
| | - Mark J Van Ryzin
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd. Eugene, OR, 97401,
| | - Matthew Lambert
- University of Nebraska-Lincoln, University of Nebraska-Lincoln, 273 Barkley Memorial Center, University of Nebraska-Lincoln, Lincoln, NE, 68583-0732,
| | - Amy L Stevens
- Father Flanagan's Boys Home, 14100 Crawford St. Boys Town, NE 68010,
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Gross TJ, Hurley KD, Lambert MC, Epstein MH, Stevens AL. Psychometric Evaluation of the Symptoms and Functioning Severity Scale (SFSS) Short Forms with Out-of-Home Care Youth. CHILD & YOUTH CARE FORUM 2015; 44:239-249. [PMID: 26380541 PMCID: PMC4568760 DOI: 10.1007/s10566-014-9280-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is a need for brief progress monitoring measures of behavioral and emotional symptoms for youth in out-of-home care. The Symptoms and Functioning Severity Scale (SFSS; Bickman et al., 2010) is one measure that has clinician and youth short forms (SFSS-SFs); however, the psychometric soundness of the SFSS-SFs with youth in out-of-home care has yet to be examined. OBJECTIVE The objective was to determine if the psychometric characteristics of the clinician and youth SFSS-SFs are viable for use in out-of-home care programs. METHODS The participants included 143 youth receiving residential treatment and 52 direct care residential staff. The current study assessed internal consistency and alternate forms reliability for SFSS-SFs for youth in a residential care setting. Further, a binary classification test was completed to determine if the SFSS-SFs similarly classified youth as the SFSS full version for low- and elevated-severity. RESULTS The internal consistency for the clinician and youth SFSS-SFs was adequate (α = .75 to .82) as was the parallel forms reliability (r = .85 to .97). The sensitivity (0.80 to 0.95), specificity (0.88 to 0.97), and overall accuracy (0.89 to 0.93) for differentiating low and elevated symptom severity was acceptable. CONCLUSIONS The clinician and youth SFSS-SFs have acceptable psychometrics and may be beneficial for progress monitoring and additional research should clarify their potential for progress monitoring of youth in out-of-home programs.
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Affiliation(s)
- Thomas J. Gross
- University of Nebraska – Lincoln, 213 Barkley Memorial Center, Lincoln, NE 68583, 402-472-5484
| | - Kristin Duppong Hurley
- University of Nebraska – Lincoln, 247E Barkley Memorial Center, Lincoln, NE 68583, 402-472-5501
| | - Matthew C. Lambert
- University of Nebraska – Lincoln, 273 Barkley Memorial Center, Lincoln, NE 68583, 402-472-5487
| | - Michael H. Epstein
- University of Nebraska – Lincoln, 202F Barkley Memorial Center, Lincoln, NE 68583, 402-472-5472
| | - Amy L. Stevens
- National Research Institute at Father Flanagan’s Boys’ Home, 100 Crawford Drive, Boys Town, NE 68010
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Validation of the symptoms and functioning severity scale in residential group care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 42:356-62. [PMID: 25037614 DOI: 10.1007/s10488-014-0575-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tests that measure the emotional and behavioral problems of children and youth are typically not normed and standardized on youth diagnosed with disruptive behavior, particularly those youth in residential care. Yet professional standards mandate that before instruments are used with a specific population the psychometric properties need to be studied and re-established: specifically, psychometric properties, including validity, need to be evaluated (AERA, APA, and NCME, The standards for educational and psychological testing. AERA, Washington, DC, 1999). The purpose of the present study was to assess the validity characteristics of the Symptoms and Functioning Severity Scale (SFSS; Bickman et al., Manual of the Peabody Treatment Progress Battery, Vanderbilt University, Nashville, TN, 2010), a widely used test developed for use in outpatient clinics, with youth in a residential care program. The convergent validity of the SFSS was established with the large correlations (0.78-0.86) with the CBCL. Several binary classification analyses including specificity, area under the receiver operating characteristic curve, positive and negative likelihood ratios, and the Youden Index supported the validity of the SFSS. However, the sensitivity index was somewhat low indicating the test may produce a high level of false negatives. Limitations, future research and implications are discussed.
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Measurement Properties of the Motivation for Youth Treatment Scale with a Residential Group Home Population. CHILD & YOUTH CARE FORUM 2013; 42. [PMID: 24288450 DOI: 10.1007/s10566-013-9217-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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