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照顾者-治疗师联盟。治疗联盟是临床医生和客户最重要的问题，它与成人和儿童心理治疗研究的结果有关。虽然2000多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联盟，更少的研究在日常护理儿童心理治疗中研究联盟。由于对联盟的时间稳定性或联盟多个视角的一致性知之甚少，本研究将首先解决跨越时间和信息者衡量联盟的复杂性。此外，这项研究将考察联盟与儿童、照顾者和家庭中的治疗变化之间的关系(即，根据谁的说法，谁的联盟与哪些结果最相关)。最后，如果发现显著的联盟-结果关联，则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，这些假设可以改变为影响联盟；因此，它对指导实践和改善护理具有重要意义。具有代表性的样本包括219名有破坏性行为问题的儿童，他们接受了通常的护理。 治疗联盟和各种结果将在整个心理治疗过程中进行评估，最多在开始心理治疗后16个月。此外，心理治疗过程的编码录像带将提供有关可能影响治疗联盟实力的治疗师行为的信息。编码录像带还允许对儿童治疗师和照顾者/治疗师联盟提供额外的视角(即观察者报告)。公共卫生相关性：拟议的研究在日常护理儿童心理治疗的背景下审查了一个具有很大临床相关性和实用性的问题。它解决了几个方法论问题，这些问题在儿童心理治疗联盟文献中还没有得到很好的研究，它进一步有助于目前关于联盟结果关联的知识。这项研究有可能帮助弥合研究与实践之间的差距，因为它具有强大的生态有效性，并关注具有很大临床相关性和实用性的问题。更好地理解社区精神卫生服务中的治疗联盟是有价值的，因为它最终将有助于改善对儿童的护理。

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.