Therapist Alliance-Building Behaviors, Alliance, and Outcomes in Cognitive Behavioral Treatment for Youth Anxiety Disorders

被引:10
|
作者
Fjermestad, Krister W. [1 ]
Foreland, Oyvind [1 ,2 ]
Oppedal, Silje B. [1 ,3 ]
Sorensen, Julie S. [1 ,3 ]
Vognild, Ylva H. [1 ,4 ]
Gjestad, Rolf [5 ]
Ost, Lars-Goran [6 ]
Bjaastad, Jon F. [7 ,8 ]
Shirk, Stephen S. [9 ]
Wergeland, Gro Janne [10 ,11 ]
机构
[1] Univ Oslo, Dept Psychol, POB 1094, N-0317 Oslo, Norway
[2] Sorlandet Reg Hosp Trust, Dept Addict Med, Arendal, Norway
[3] Oslo Educ & Psychol Counselling Serv, Oslo, Norway
[4] Diakonhjemmet Hosp, Vinderen Adult Mental Hlth Serv, Oslo, Norway
[5] Haukeland Hosp, Div Psychiat, Res Dept, Bergen, Norway
[6] Stockholm Univ, Dept Psychol, Stockholm, Sweden
[7] Stavanger Univ Hosp, Div Psychiat, Stavanger, Norway
[8] NORCE Norwegian Res Ctr, Reg Ctr Child & Youth Mental Hlth & Child Welfare, Bergen, Norway
[9] Univ Denver, Dept Psychol, Denver, CO 80208 USA
[10] Haukeland Hosp, Div Psychiat, Dept Child & Adolescent Psychiat, Bergen, Norway
[11] Univ Bergen, Fac Med, Dept Clin Med, Bergen, Norway
关键词
OBSERVATIONAL CODING SYSTEM; PSYCHOMETRIC PROPERTIES; THERAPEUTIC ALLIANCE; CHILD; SCALE; CBT; ADOLESCENTS; PREDICTION; PATIENT;
D O I
10.1080/15374416.2019.1683850
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Objective: The alliance influences outcomes in CBT for youth anxiety disorders. Thus, knowledge about how therapists can enhance the alliance is needed. Method: Seventy-three youth with anxiety diagnoses (M age = 11.5 years, SD = 2.2; range 8 to 15 years; 47.9% boys; 90.4% white-European) participated in 10-session cognitive behavioral therapy in community clinics. Therapist alliance-building behaviors in session 2 was reliably coded with the observer-rated Adolescent Alliance-Building Behavior Scale (Revised) (AABS(R)). Alliance was measured as youth- and therapist-rated alliance, and youth-therapist alliance discrepancy in session 3. Outcomes were diagnostic recovery and anxiety symptom reduction at post-treatment and one-year follow-up, and treatment dropout. We examined the direct effects of alliance-building on alliance, alliance on outcomes, and alliance-building on outcomes in multilevel mediation models, and between- versus within-therapist variance across these effects. Results: The alliance-building behaviors collaborate, present treatment model, and explore motivation positively predicted alliance, whereas actively structuring the session (i.e., dominating) negatively predicted alliance. The alliance-building behaviors attend to experience, collaborate, explore motivation, praise, and support positively predicted outcomes. The alliance-building behaviors present treatment model, express positive expectations, explore cognitions, and support negatively predicted outcomes. The effect of collaborate on symptom reduction was mediated by youth-therapist alliance discrepancy. There was almost zero between-therapist variance in alliance-building, and considerable within-therapist variance. Conclusion: Therapist alliance-building behaviors were directly (positively and negatively) associated with alliance and/or outcomes, with only one effect mediated by alliance. Alliance-building behaviors varied far more within therapists (i.e., across clients) than between therapists.
引用
收藏
页码:229 / 242
页数:14
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