Therapeutic Alliance: A Comparison Study between Adolescent Patients and Their Therapists.

Vera Gergov,Mauri Marttunen,Nina Lindberg,Jari Lahti,Jari Lipsanen

doi:10.3390/ijerph182111238

Abstract

The aim of this study was to examine the congruence of adolescent- and therapist-rated therapeutic alliance, and to explore which rating or combination of ratings would predict treatment outcome or premature termination. We also studied whether the alliance changes over the course of treatment and if the change is related to the outcome or dropout. This study comprised 58 adolescents clinically referred for psychotherapeutic interventions. The alliance (Working Alliance Inventory, patient/therapist ratings) and treatment outcomes (Beck Depression Inventory, Clinical Outcomes in Routine Evaluation—Outcome Measure) were measured at baseline and at 3-, 6-, and 12-month follow-ups. The alliance did not change significantly over the course of therapy, but adolescent and therapist ratings did not correlate. Low values in the early assessment of adolescent-rated alliance and discrepancy between the ratings were significant predictors of undesirable treatment outcome. Weak adolescent- or therapist-rated alliance later in treatment and change for the worse in adolescent-rated alliance was associated with treatment dropout. As adolescent-rated alliance predicts treatment outcome better than therapist-rated alliance, therapists should frequently use assessments of therapeutic relationship within the therapy and pay attention if the adolescent feels the alliance is weakening or his/her evaluation is contrary to the therapist’s.

Highlights

Published: 26 October 2021Mental health problems increase substantially in adolescence
The mean levels of perceived therapeutic alliance reported by patients (WAI-P) and therapists (WAI-T) did not significantly differ from each other at baseline (t(52) = −1.67, p = 0.10), 3-month follow-up (t(54) = −0.85, p = 0.40), 6-month follow-up (t(44) = −1.11, p = 0.28), or 12-month follow-up (t(37) = −1.16, p = 0.25) (Table 1)
In the linear mixed effect models, overall association between adolescent and therapist alliance measures was positive and statistically significant (p = 0.02, r2 = 0.04), but the association did not change in time

Summary

Introduction

Mental health problems increase substantially in adolescence. Of lifetime diagnosed mental health disorders manifest by the age of 14, and the amount increases to 75% by the age of 24 [1] Psychotherapeutic interventions are effective among adolescents for treating mental disorders [2,3]. In order to find out the real-life effectiveness of psychotherapy, researchers have in recent years encouraged studies of clinically referred youths and of treatments delivered in clinical service settings [3]. The therapists usually need to be more active and take a more directive role in the treatment of adolescents [7] in order to gain their trust and form a confidential relationship with the adolescent

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