Factor Structure and Validity of the Therapy Process Observational Coding System for Child Psychotherapy–Alliance Scale

Abstract

The aim of this study was to examine the factor structure and psychometric properties of an observer-rated youth alliance measure, the Therapy Process Observational Coding System for Child Psychotherapy–Alliance scale (TPOCS–A). The sample was 52 youth diagnosed with anxiety disorders (M age = 12.43, SD = 2.23, range = 8–15; 56% boys; 98% Caucasian) drawn from a randomized controlled trial. Participants received a manualized individual cognitive behavioral treatment, the FRIENDS for life program, in public community clinics in Norway. Diagnostic status, treatment motivation, and perceived treatment credibility were assessed at pretreatment. Using the TPOCS–A, independent observers rated child–therapist alliance from the third therapy session. Child- and therapist-reported alliance measures were collected from the same session. An exploratory factor analysis supported a one-factor solution, which is consistent with previous studies of self- and observer-rated youth alliance scales. Psychometric analyses supported the interrater reliability, internal consistency, and convergent/divergent validity of the TPOCS–A. Accumulating psychometric evidence indicate that the TPOCS–A has the potential to fill a measurement gap in the youth psychotherapy field. In youth psychotherapy, alliance may be unidimensional, so establishing a strong bond and engaging the child in therapeutic activities may both be instrumental to establishing good alliance early in treatment. However, it is important to be cautious when interpreting the factor analytic findings, because the sample size may have been too small to identify additional factors. Future research can build upon these findings by examining the factor structure of youth alliance measures with larger, more diverse samples.

Acknowledgments

This study is a part of the project “Assessment and Treatment—Anxiety in Children and Adults (ATACA) Child Part” and has received support from the Western Norway Regional Health Authority, through Project No. 911366 and Project No. 911253. This study was supported by “The National Program for Integrated Clinical Specialist and PhD-training for Psychologists” in Norway. This program is a joint cooperation between the Universities of Bergen, Oslo, Tromsø, The Norwegian University of Science and Technology (Trondheim), the Regional Health Authorities, and the Norwegian Psychological Association. The program is funded jointly by The Ministry of Education and Research and The Ministry of Health and Care Services, and the Meltzer Research Foundation, University of Bergen, Norway. There are no conflicts of interest. Marianne Christensen and Randi Sigrun Skogstad assisted with coding of treatment sessions, and Torbjørn Torsheim provided statistical input.

Notes

Note: SP = social phobia; SAD = separation anxiety disorder; GAD = generalized anxiety disorder.

Note:. Convergent validity represents the correlation between the Therapy Process Observational Coding System for Child Psychotherapy–Alliance scale (TPOCS–A) and the Therapeutic Alliance Scale for Children. ICC = intraclass correlation coefficient.

Note: ICC = intraclass correlation coefficient; TPOCS-A = Therapy Process Observational Coding System for Child Psychotherapy–Alliance Scale; M =mean; SD =standard deviation.

^a Bond subscale.

^b Task subscale.

^c Item score is reversed.

Note: TPOCS–A = Therapy Process Observational Coding System for Child Psychotherapy-Alliance Scale; TASC–C = Therapeutic Alliance Scale for Children–Child version; TASC–T = Therapeutic Alliance Scale for Children–Therapist version; NML = Nijmegen Motivation List; CS = Credibility Scale.

Note: TPOCS–A = Therapy Process Observational Coding System for Child Psychotherapy–Alliance Scale; TASC–C = Therapeutic Alliance Scale for Children–Child version; TASC–T = Therapeutic Alliance Scale for Children–Therapist version; NML = Nijmegen Motivation List; CS = Credibility Scale.

*p < .05. **p < .01.