Therapist and client perspectives on the alliance in the treatment of traumatized adolescents

Figures & data

Table 1 Adolescent and therapist ratings of the alliance across treatment conditions

Scale	Group	n	Mean score	SD^a	Df	t	p
Adolescent-rated TASC-r	TF-CBT TAU	65 65	38.1 38.0	7.6 8.0	128	0.5	0.964
Therapist-rated TASC-r	TF-CBT TAU	64 62	35.9 34.9	5.4 7.0	124	0.9	0.364
Therapist—adolescent discrepancy	TF-CBT TAU	61 59	−1.9 −2.9	8.6 7.0	118	0.7	0.490

TASC-r, therapeutic alliance scale for children revised.

^aTest of homogeneity of variance: all Levene p≥0.05.

Fig. 1 Divergence of therapists’ and adolescents’ alliance ratings. Diagonal thick line=no divergence between therapist and adolescent ratings; diagonal thin line=regression line; dashed horizontal line=mean therapist ratings; and dashed vertical line=mean adolescent rating.

Table 2 Linear regressions with adolescent and therapist alliance ratings and outcome

	Est.	95% CI	p	Stand. est.^a
Adolescent-rated PTSS posttreatment
Pretreatment CPSS	0.48	0.23–0.72	<0. 001	0.32
Adolescent-rated alliance	−0.33	−0.61–− 0.04	0.024	−0.22
Therapist-rated alliance	0.29	−0.09–0.67	0.138	0.13
Clinical-rated PTSS post-treatment
Pretreatment CAPS-CA	0.60	0.40–0.81	<0.001	0.46
Adolescent-rated alliance	−0.58	−1.26–0.10	0.092	−0.15
Therapist-rated alliance	0.75	−0.22–1.72	0.129	0.14
Adolescents’ treatment satisfaction
Change in CPSS scores pre-post	0.06	0.03–0.10	<0.001	0.17
Adolescent-rated alliance	0.15	0.09–0.21	<0.001	0.29
Therapist-rated alliance	0.14	0.06–0.22	<0.001	0.60

CPSS, Child PTS Symptom scale; CAPS-CA, clinical diagnostic interview of adolescents’ PTSS. Table presented with multiply imputed data.

^aStandardized estimates are based on regression coefficients from imputed data and standard deviations from complete cases.

Table 3 Correlations between alliance scales and outcome measures

	1	2	3	4	5
1. Adolescent-rated alliance
2. Therapist-rated alliance	0.39***
3. Change in CPSS pre-post	0.15	−0.02
4. Change in CAPS-CA pre-post	0.13	−0.04	0.68***
5. Child satisfaction	0.56***	0.43***	0.32***	0.24**

CPSS, Child PTS Symptom scale; CAPS-CA, clinical diagnostic interview of adolescents’ PTSS.

***p<0.001, *p<0.010, *p<0.050.

Table 4 Factor loadings for exploratory factor analyses with geomin rotation for adolescent and therapist TASC-r scales

	Adolescent scale		Therapist scale
Item	Factor 1	Factor 2	Factor 1	Factor 2
Item 1	0.64*	0.29*	0.99*	−0.08
Item 2r	0.49*	0.29*	0.13	0.56*
Item 3	0.27*	0.65*	0.78*	0.14
Item 4	0.00	0.88*	0.00	0.95*
Item 5r	0.93*	−0.16	0.52*	0.31
Item 6	0.77*	0.10	0.69*	0.06
Item 7r	0.62*	0.05	−0.05	0.74*
Item 8r	0.85*	0.00	0.70*	0.16
Item 9	−0.13	0.92*	−0.19	1.00*
Item 10	0.35*	0.64*	0.91*	−0.00
Item 11r	0.76*	0.05	0.07	0.77*
Item 12	0.19	0.74*	0.02	0.93*

Geomin rotated loadings, items entered as categorical. *p < 0.050. Factor loadings ≥0.40 are shown in bold. r specifies that the item is negatively worded and the scoring of the item is reversed.

Table 5 Linear regressions for therapist—adolescent discrepancy and outcome

	Est.	95% CI	p	Std est.^a
Adolescent-rated PTSS post-treatment (n=120)
Pretreatment CPSS	0.47	0.23–0.71	<0.001	0.31
Therapist—adolescent discrepancy	0.32	0.05–0.59	0.020	0.22
Clinician-rated PTSS post-treatment (n=110)
Pretreatment CAPS-CA	0.60	0.40–0.81	<0.001	0.45
Therapist—adolescent discrepancy	0.63	−0.00–1.26	0.050	0.17
Adolescents’ treatment satisfaction (n=112)
Change in CPSS scores pre—post	0.06	0.02–0.11	0.004	0.28
Therapist—adolescent discrepancy	−0.06	−0.13–0.00	0.061	−0.17

CPSS, Child PTS Symptom scale; CAPS-CA, clinical diagnostic interview of adolescents’ PTSS. Table presented with multiply imputed data.

^aStandardized estimates are based on regression coefficients from imputed data and standard deviations from complete cases.