Child involvement, alliance, and therapist flexibility: Process variables in cognitive-behavioural therapy for anxiety disorders in childhood

Jennifer L. Hudson, Philip C. Kendall, Brian C. Chu, Elizabeth Gosch, Erin Martin, Alan Taylor, Ashleigh Knight

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background: This study examined the relations between treatment process variables and child anxiety outcomes. Method: Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6-14 yr-old; M=10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up. Results: Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome. Conclusion: Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalBehaviour Research and Therapy
Volume52
Issue number1
DOIs
StatePublished - Jan 2014

All Science Journal Classification (ASJC) codes

  • Experimental and Cognitive Psychology
  • Clinical Psychology
  • Psychiatry and Mental health

Keywords

  • Alliance
  • Child anxiety
  • Child involvement
  • Flexibility
  • Therapy process

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