Child involvement, alliance, and therapist flexibility: process variables in cognitive-behavioural therapy for anxiety disorders in childhood.
BACKGROUND
This study examined the relations between treatment process variables and child anxiety outcomes.


METHOD
Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6-14 yr-old; M = 10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up.


RESULTS
Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome.


CONCLUSION
Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters.
['Hudson|Jennifer L|JL|', 'Kendall|Philip C|PC|', 'Chu|Brian C|BC|', 'Gosch|Elizabeth|E|', 'Martin|Erin|E|', 'Taylor|Alan|A|', 'Knight|Ashleigh|A|']
D000293:Adolescent D001008:Anxiety Disorders D002648:Child D015928:Cognitive Behavioral Therapy D005260:Female D006801:Humans D008297:Male D010349:Patient Compliance D011369:Professional-Patient Relations D012307:Risk Factors D011795:Surveys and Questionnaires D016896:Treatment Outcome
Child involvement Alliance Flexibility Child anxiety Therapy process