Therapist and client perspectives on the alliance in the treatment of traumatized adolescents
Objective: Client ratings of the therapeutic alliance are an important predictor of outcome in the treatment of traumatized adolescents and adults, but less is known about the therapists’ perspective. The aim of this study was to investigate how therapists’ ratings relate to the adolescents’ perspec...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2015-08-01
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| Series: | European Journal of Psychotraumatology |
| Subjects: | |
| Online Access: | http://www.ejpt.net/index.php/ejpt/article/view/27705/pdf_87 |
| _version_ | 1818039884472909824 |
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| author | Silje M. Ormhaug Stephen R. Shirk Tore Wentzel-Larsen |
| author_facet | Silje M. Ormhaug Stephen R. Shirk Tore Wentzel-Larsen |
| author_sort | Silje M. Ormhaug |
| collection | DOAJ |
| description | Objective: Client ratings of the therapeutic alliance are an important predictor of outcome in the treatment of traumatized adolescents and adults, but less is known about the therapists’ perspective. The aim of this study was to investigate how therapists’ ratings relate to the adolescents’ perspective, how individual therapist and adolescent ratings relate to change in symptoms and treatment satisfaction, and whether discrepant alliance perspectives impact treatment outcome. Method: The sample consisted of 156 youth (mean age 15.1, range 10–18), randomized to trauma-focused cognitive behavioral therapy or treatment as usual, and alliance ratings from 62 therapists. Alliance was measured midtreatment with the Therapeutic Alliance Scale for Children, and the factor structure of the two scales was analyzed with exploratory factor analyses. A change in posttraumatic symptoms was assessed with the Child PTSD Symptom Scale (CPSS) and the Clinicial-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Results: Therapist and client perspectives on the alliance were significantly, but moderately, associated (intraclass correlations [ICC]=0.54, p<0.001). Both scales predicted adolescent treatment satisfaction but only the client scale was significantly related to change in symptoms. Factor analyses revealed differences in factor structure with therapist ratings organized around bond and task dimensions and adolescent ratings organized by item valence. Higher therapist ratings compared to adolescent ratings predicted higher residual PTS symptoms. Discussion: Although adolescent and therapist alliance ratings are moderately associated, results suggest that the ratings are differentially associated with outcomes. These findings, along with results indicating important differences in factor structure, imply that adolescent and therapist ratings are not interchangeable. Future studies should investigate how therapists can improve their judgments of adolescents’ perceptions of the alliance as an overestimation of the quality of the relationship seems to be negatively related to outcome. |
| first_indexed | 2024-12-10T08:05:44Z |
| format | Article |
| id | doaj.art-9b1b44143cda4799a58957241fcde9ed |
| institution | Directory Open Access Journal |
| issn | 2000-8066 |
| language | English |
| last_indexed | 2024-12-10T08:05:44Z |
| publishDate | 2015-08-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | European Journal of Psychotraumatology |
| spelling | doaj.art-9b1b44143cda4799a58957241fcde9ed2022-12-22T01:56:41ZengTaylor & Francis GroupEuropean Journal of Psychotraumatology2000-80662015-08-016011010.3402/ejpt.v6.2770527705Therapist and client perspectives on the alliance in the treatment of traumatized adolescentsSilje M. Ormhaug0Stephen R. Shirk1Tore Wentzel-Larsen2 Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway Department of Psychology, University of Denver, Denver, CO, USA Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, NorwayObjective: Client ratings of the therapeutic alliance are an important predictor of outcome in the treatment of traumatized adolescents and adults, but less is known about the therapists’ perspective. The aim of this study was to investigate how therapists’ ratings relate to the adolescents’ perspective, how individual therapist and adolescent ratings relate to change in symptoms and treatment satisfaction, and whether discrepant alliance perspectives impact treatment outcome. Method: The sample consisted of 156 youth (mean age 15.1, range 10–18), randomized to trauma-focused cognitive behavioral therapy or treatment as usual, and alliance ratings from 62 therapists. Alliance was measured midtreatment with the Therapeutic Alliance Scale for Children, and the factor structure of the two scales was analyzed with exploratory factor analyses. A change in posttraumatic symptoms was assessed with the Child PTSD Symptom Scale (CPSS) and the Clinicial-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Results: Therapist and client perspectives on the alliance were significantly, but moderately, associated (intraclass correlations [ICC]=0.54, p<0.001). Both scales predicted adolescent treatment satisfaction but only the client scale was significantly related to change in symptoms. Factor analyses revealed differences in factor structure with therapist ratings organized around bond and task dimensions and adolescent ratings organized by item valence. Higher therapist ratings compared to adolescent ratings predicted higher residual PTS symptoms. Discussion: Although adolescent and therapist alliance ratings are moderately associated, results suggest that the ratings are differentially associated with outcomes. These findings, along with results indicating important differences in factor structure, imply that adolescent and therapist ratings are not interchangeable. Future studies should investigate how therapists can improve their judgments of adolescents’ perceptions of the alliance as an overestimation of the quality of the relationship seems to be negatively related to outcome.http://www.ejpt.net/index.php/ejpt/article/view/27705/pdf_87Working allianceyouth and therapist perspectivesdiscrepant alliance ratingsposttraumatic stress disorderexploratory factor analyses |
| spellingShingle | Silje M. Ormhaug Stephen R. Shirk Tore Wentzel-Larsen Therapist and client perspectives on the alliance in the treatment of traumatized adolescents European Journal of Psychotraumatology Working alliance youth and therapist perspectives discrepant alliance ratings posttraumatic stress disorder exploratory factor analyses |
| title | Therapist and client perspectives on the alliance in the treatment of traumatized adolescents |
| title_full | Therapist and client perspectives on the alliance in the treatment of traumatized adolescents |
| title_fullStr | Therapist and client perspectives on the alliance in the treatment of traumatized adolescents |
| title_full_unstemmed | Therapist and client perspectives on the alliance in the treatment of traumatized adolescents |
| title_short | Therapist and client perspectives on the alliance in the treatment of traumatized adolescents |
| title_sort | therapist and client perspectives on the alliance in the treatment of traumatized adolescents |
| topic | Working alliance youth and therapist perspectives discrepant alliance ratings posttraumatic stress disorder exploratory factor analyses |
| url | http://www.ejpt.net/index.php/ejpt/article/view/27705/pdf_87 |
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