Child-therapist and caregiver-therapist alliance in usual care psychotherapy

描述（由申请人提供）：本研究的主要目的是研究接受社区心理健康服务的家庭中的儿童治疗师和照顾者-治疗师联盟。治疗联盟对临床医生和客户来说是一个至关重要的问题，它与成人和儿童心理治疗研究的结果有关。虽然有超过2000项研究在成人心理治疗的背景下考察了客户-治疗师联盟，但很少有研究在儿童或家庭心理治疗的背景下考察了联盟，而在常规护理儿童心理治疗中调查联盟的研究就更少了。由于对联盟的时间稳定性或对联盟的多种观点的一致性知之甚少，本研究将首先解决跨时间和信息者衡量联盟的复杂性。此外，本研究将检查联盟与儿童、照顾者和家庭的治疗变化之间的关系（即，谁的联盟，根据谁，与哪种结果最密切相关）。最后，如果发现显著的联盟-结果关联，将探索与联盟相关的治疗师特征和行为。最后一个目标可能会产生关于治疗师行为的假设，这些行为可能会改变以影响联盟；因此，它对告知实践和改善护理具有重要意义。代表性样本包括219名有破坏性行为问题的儿童，他们接受常规护理。

DESCRIPTION (provided by applicant): The broad goal of the proposed research is to examine child-therapist and caregiver-therapist alliance in families receiving community mental health services. Therapeutic alliance is an issue of paramount importance to clinicians and clients, and it is associated with outcomes in adult and child psychotherapy research. While over 2000 studies have examined the client-therapist alliance within the context of adult psychotherapy, very few studies have examined alliance within the context of child or family psychotherapy, and even fewer have investigated alliance in usual care child psychotherapy. Since little is known about the temporal stability of alliance or concordance of multiple perspectives on alliance, the proposed study will first address the complexities of measuring alliance across time and informants. Furthermore, this study will examine the association between alliance and therapeutic change in the child, caregiver, and family (i.e., whose alliance, according to whom, is most strongly associated with which outcomes). Finally, if significant alliance-outcome associations are found, therapist characteristics and behaviors associated with alliance will be explored. This last aim may generate hypotheses about therapist behaviors that could be changed to impact alliance; thus, it has significant implications for informing practice and improving care. The representative sample includes 219 children with disruptive behavior problems receiving usual care. Therapeutic alliance and various outcomes will be assessed throughout the course of psychotherapy, up to 16 months after initiating psychotherapy. In addition, coded videotapes of psychotherapy sessions will provide information about therapist behaviors that might impact therapeutic alliance strength. Coded videotapes also allow for an additional perspective (i.e., observer report) on child-therapist and caregiver/therapist alliance. PUBLIC HEALTH RELEVANCE: The proposed study examines an issue of great clinical relevance and utility within the context of usual care child psychotherapy. It addresses several methodological questions that have not been well-studied in the child psychotherapy alliance literature, and it further contributes to current knowledge about alliance outcome associations. This research has the potential to help bridge the research-practice gap because of its strong ecological validity and attention to issues of great clinical relevance and utility. Better understanding of therapeutic alliance in community mental health services is valuable because it will ultimately inform improvements in care for children.