Do caregivers’ perspectives matter? Working alliances and treatment outcomes in trauma-focused cognitive behavioural therapy with children and adolescents

Figures & data

Figure 1. Therapeutic triad and perspectives measured

Table 1. Socio-demographic and clinical characteristics of patients (N = 76)

Mean age (SD), years	12.66 (2.92)
Gender, n (%)
Male	23 (30.3)
Female	53 (69.7)
Country of birth, n (%)
Germany	68 (89.5)
Other	5 (6.5)
Living situation, n (%)
With both parents	17 (22.4)
With one parent	44 (57.9)
With foster parents	2 (2.6)
Group home	9 (11.8)
With other relatives	2 (2.6)
Other	1 (1.3)
Parental education, n (%)
<9 years’ school education	1 (1.8)
9–11 years’ school education	38 (66.7)
>12 years’ school education	17 (29.8)
Number of traumatic event types, M (SD)	6.26 (3.45)
Type of index event, n (%)
Interpersonal (occurs between people)	61 (80.3)
Accidental (caused by a random event)	15 (19.7)
Quality of index trauma, n (%)
Sexual abuse	31 (40.8)
Physical violence	27 (35.5)
Death of a close person	9 (11.8)
Others	9 (11.8)
Comorbid disorder DSM-IV, n (%)
None	2 (68.4)
≥1 comorbid disorder	24 (31.6)

Note: Missing values: N = 1 (living situation), N = 3 (country of birth), N = 13 (parental education)

Table 2. Means and standard deviations of sum scores of the Working Alliance Inventory short form (WAI-S) from four perspectives at mid-treatment and post-treatment; mean differences with paired t-tests, effect sizes (Cohens d)

WAI-S sum score	n	Mid-treatment Mean SD		n	Post-treatment Mean SD		t	df	p	d
Therapist-to-Patient	65	65.15	11.01	67	67.24	11.59	3.16	63	<.01	.40
Patient-to-Therapist	51	71.43	10.78	58	74.88	9.94	2.83	49	.01	.40
Therapist-to-Caregiver	65	64.55	12.91	67	66.63	13.41	2.04	64	.05	.25
Caregiver-to-Therapist	53	76.19	6.412	67	76.49	6.08	−.87	50	.39	.12

Table 3. Pearson correlation matrix for WAI and CAPS-CA ratings (mid- and post-treatment)

	1.	2.	3.	4.	5.	6.	7.	8.	9.	10.
1. WAI-S-T (mid)	–
2. WAI-S-T (post)		–
3. WAI-S-P (mid)	.369**		–
4. WAI-S-P (post)		.659**		–
5. WAI-S-TC (mid)	.489**		.144		–
6. WAI-S-TC (post)		.664**		.499**		–
7. WAI-S-CT (mid)	.163		.436**		.169		–
8. WAI-CT (post)		.311*		.334*		.317*		–
9. CAPS-CA (baseline)	−.021		.133		−.130		−.119		–
10. CAPS-CA (post)		−.390*		−.414**		−.364**		−.285a		–

*p < .05; **p < .01 CAPS-CA = Clinician-Administered PTSD Scalefor Children and Adolescents; WAI-S-T = WorkingAlliance Inventory short form Therapist-to-Patient; 470WAI-S-P = Working Alliance Inventory short formPatient-to-Therapist; WAI-S-TC = Working AllianceInventory short form Therapist-to-Caregiver; WAIS-CT = Working Alliance Inventory short form Caregiver-to-Therapist.

Table 4. Results of the mixed-effects regression analysis

	CAPS-CA
	Coeff.	SE	p	95% CI
Model 1 (Therapists with patients)
Time	−28.928	3.368	.000	−35.529	−22.326
WAI-S-T	−.291	.155	.061	−.595	.013
Time*WAI-S-T	−.347	.296	.241	−.927	−.233
WAI-S-P	.194	.126	.125	−.054	.441
Time*WAI-S-P	−.682	.331	.039	−1.332	−.033
Model 2 (Therapists with caregivers)
Time	−25.101	3.094	.000	−31.165	−19.037
WAI-S-TC	−.245	.224	.274	−.684	.194
Time*WAI-S-TC	−.807	.264	.002	−1.325	−.287
WAI-S-CT	−.108	.463	.816	−1.015	.799
Time*WAI-S-CT	−.522	.597	.382	−1.692	.647

CAPS-CA = Clinician-Administered PTSD Scale for Children and Adolescents; WAI-S-T = Working Alliance Inventory short form Therapist-to-Patient; WAI-S-P = Working Alliance Inventory short form Patient-to-Therapist; WAI-S-TC = Working Alliance Inventory short form Therapist-to-Caregiver; WAI-S-CT = Working Alliance Inventory short form Caregiver-to-Therapist.

Data availability statement

Given that the ethical committee agrees, the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request ([email protected]).