Therapist Alliance-Building Behavior Within a Cognitive-Behavioral Treatment for Anxiety in Youth.

TLDR

The study examined which therapist behaviors influence youth clients’ perceptions of therapeutic alliance during a manualized CBT program for anxiety disorders. Researchers coded 11 therapist behaviors in the first three sessions of 56 youth and collected child, therapist, and observer alliance ratings after sessions 3 and 7. Collaboration predicted higher early child alliance, while finding common ground and pushing the child to talk predicted lower early child alliance; by session 7, collaboration and a relaxed style predicted higher therapist alliance, and all alliance ratings were significantly correlated, highlighting potential strategies for strengthening the child‑therapist alliance.

Abstract

Explored the specific behavior of therapists contributing to a child client's perception of a therapeutic alliance with youth (n = 56) who received a manualized cognitive-behavioral treatment for anxiety disorders. The first 3 sessions were coded for 11 therapist behaviors hypothesized to predict ratings of alliance. Child, therapist, and observer alliance ratings were gathered after the 3rd and 7th therapy sessions. "Collaboration" positively predicted early child ratings of alliance, and "finding common ground" and "pushing the child to talk" negatively predicted early child ratings of alliance. Although no coded therapist behaviors predicted early therapist ratings of alliance, "collaboration" and "not being overly formal" positively predicted therapist alliance ratings by Session 7. Child, observer, and therapist ratings of alliance were significantly correlated. Results are discussed with regard to the identified behavior of the therapist as a step toward the identification of empirically supported strategies for building a stronger child-therapist alliance.