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

描述（由申请人提供）：拟议研究的广泛目标是检查接受社区精神卫生服务的家庭中的儿童治疗师和儿童治疗师联盟。治疗联盟是一个至关重要的问题，临床医生和客户，它与成人和儿童心理治疗研究的成果。虽然有超过2000项研究在成人心理治疗的背景下研究了客户-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研究了联盟，甚至更少的研究了通常护理儿童心理治疗中的联盟。由于很少有人知道联盟的时间稳定性或联盟的多个角度的一致性，拟议的研究将首先解决跨时间和线人测量联盟的复杂性。此外，这项研究将检查联盟和治疗变化之间的关联，在儿童，照顾者和家庭（即，谁与谁的关系最密切，谁与谁的关系最密切。最后，如果发现显著的联盟结果协会，治疗师的特点和行为与联盟将被探讨。这最后一个目标可能会产生的假设治疗师的行为，可以改变影响联盟，因此，它具有重要意义的通知实践和改善护理。具有代表性的样本包括219名儿童的破坏性行为问题，接受常规护理。 治疗联盟和各种结果将在整个心理治疗过程中进行评估，直到开始心理治疗后16个月。此外，心理治疗会议的编码录像带将提供有关治疗师行为的信息，这些行为可能会影响治疗联盟的强度。编码录像带还允许额外的视角（即，观察员报告）。公共卫生相关性：拟议中的研究探讨了一个问题，具有很大的临床意义和实用性的背景下，通常的照顾儿童心理治疗。它解决了几个方法论的问题，还没有得到很好的研究，在儿童心理治疗联盟的文献，它进一步有助于目前的知识联盟的结果协会。这项研究有可能帮助弥合研究与实践之间的差距，因为它具有很强的生态有效性，并关注具有重大临床意义和实用性的问题。更好地了解社区精神卫生服务中的治疗联盟是有价值的，因为它最终将为儿童护理的改善提供信息。

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.