Abstract
We investigated the potential role of first-session therapeutic alliance ratings to serve as an early marker of treatment outcome in youth mental health and addiction treatment. The present study is among the first to incorporate both a youths’ and a therapists’ perspective of the therapeutic alliance in order to maximize predictive value of the alliance for treatment outcome. One hundred and twenty-seven adolescents participated in a multi-site prospective naturalistic clinical cohort study, with assessments at baseline and at 4 months post-baseline. Main outcome measure was favorable or unfavorable treatment outcome status at 4-month follow-up. Early therapeutic alliance had a medium and robust association with treatment outcome for youth’ (b = 1.29) and therapist’ (b = 1.12) perspectives and treatment setting. Based on the two alliance perspectives four subgroups were distinguished. Incorporating the alliance-ratings from both perspectives provided a stronger predictor of treatment outcome than using one perspective. Youth with a strong alliance according to both perspectives had an eightfold odds of favorable treatment outcome compared with youth with a weak alliance according to both perspectives. The association between therapeutic alliance and treatment outcome in youth mental health and addiction treatment may be substantially stronger than earlier assumed when both a youths’ and therapists’ perspective on alliance is considered.
Highlights
Mental disorders with severe impairment—including substance use disorders (SUD)—affect about one in four to five youths aged 13–18 years in their lifetime [1, 2]
The aims of our study were to investigate the prognostic importance of first-session youth- and therapist-rated therapeutic alliance and the added predictive value of incorporating these alliance ratings for outcome of youth in YMHC and YAC
Our findings suggest that incorporating the alliance perspectives of both youths and therapists provides substantially stronger predictive value for treatment outcome than using one perspective only
Summary
Mental disorders with severe impairment—including substance use disorders (SUD)—affect about one in four to five youths aged 13–18 years in their lifetime [1, 2]. For these young people a range of evidence-based treatments is available, including cognitive behavioral therapy and family-based treatments. Weisz et al [3] found a mean between-groups effect-size of Cohen’s d = 0.46 (medium effect) at the end of treatment, in a metaanalysis of 447 randomized controlled trials of psychological youth mental health therapies. Meta-analyses of youth with SUD showed comparable treatment effectiveness across different treatment types [4, 5]. A considerable proportion of treatment-seeking adolescents do not benefit from mental health/addiction treatment, no treatment is clearly superior, and it is largely unknown which adolescents benefit most from which type(s) of treatment
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