Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges.

Hazel Fernandes

doi:10.3389/fpsyg.2021.610874

Abstract

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy (CBT) and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field.

Highlights

Background and RationaleIn Psychotherapeutic settings, the relationship between the clinician and the client is essential and complex, it is an important factor for effective practice
Attention Deficit Hyperactivity Disorder The results showed that alliance was significantly higher in those engaged in cognitive behaviour therapy (CBT)-planning implementation module (PML) (Structured CBT), it did not translate into better treatment outcomes and did not play a role in symptom improvement (Boyer et al, 2018)
Children with autism have social, behavioural, and communication difficulties (Frye, 2018) which can impact alliance formation. It is noted from the study results that early bond and task collaboration had no effect on alliance but did later in the therapy (Albaum et al, 2020). Autism renders these children extremely sensitive to their often rigid views and perception (Mazefsky and White, 2014), and the study findings indicate that emotion regulation is influenced by therapeutic alliance and child reported emotion response inhibition which tended to improve the therapeutic bond, influencing the therapeutic process (Albaum et al, 2020)

Summary

Introduction

Background and RationaleIn Psychotherapeutic settings, the relationship between the clinician and the client is essential and complex, it is an important factor for effective practice. The conditions need to be optimised and, in therapy, both the therapist and client need to collaborate, innovate, and re-evaluate goals and find common grounds to allow for the achievement of goals agreed at the beginning of therapy. Cognitive behavioural therapy (CBT), traditionally seen as manual-based therapy, allows for the little opportunity for the development of a therapeutic relationship. In their book, Sanders and Wills (1999) expressed the view that therapists drawn to CBT tended to lose interest in it due to this lack of emphasis on the therapeutic relationship. Wolfe and Goldfried (1988) called a therapeutic alliance, “the quintessential integrative variable” of therapy. Norcross (2010) defined the therapeutic alliance as referring to “the quality and strength of the collaborative relationship between client and therapist, typically measured as agreement on the therapeutic goals, consensus on treatment tasks, and a relationship bond.” Others reported that too much emphasis was placed on “the technical aspects of therapy,” rather than focusing on the perception of the client on the “relationship with the therapist” (Duncan et al, 2010). Wolfe and Goldfried (1988) called a therapeutic alliance, “the quintessential integrative variable” of therapy. Norcross (2010) defined the therapeutic alliance as referring to “the quality and strength of the collaborative relationship between client and therapist, typically measured as agreement on the therapeutic goals, consensus on treatment tasks, and a relationship bond.”

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