Ormhaug Silje M, Jensen Tine K, Wentzel-Larsen Tore, Shirk Stephen R
Norwegian Centre for Violence and Traumatic Stress Studies.
Norwegian Centre for Violence and Traumatic Stress Studies and Department of Psychology, University of Oslo.
J Consult Clin Psychol. 2014 Feb;82(1):52-64. doi: 10.1037/a0033884. Epub 2013 Jul 29.
We examined the contribution of alliance to the outcome of therapy with traumatized youths across two different treatment conditions (trauma-focused cognitive behavioral therapy [TF-CBT] and therapy as usual [TAU]).
Participants were 156 youths (M age = 15.1 years, range = 10-18; 79.5% girls), randomly assigned to TF-CBT or TAU. Symptoms were assessed pretreatment, midtreatment (Session 6), and posttreatment (Session 15). Alliance was assessed after Sessions 1 and 6, using the Therapeutic Alliance Scale for Children-Revised (TASC-R).
Alliance scores were comparable across treatment conditions, but TF-CBT participants had significantly lower posttraumatic stress symptoms (PTSS) posttreatment (d = 0.51). Hierarchical regression analyses showed that there were no significant alliance effects in models without an Alliance × Treatment Group interaction: Alliance ratings were significant predictors of reduction in PTSS (Est. = -0.53, p = .003, 95% confidence interval [CI] = -0.87 to -0.18) and additional outcomes measured in TF-CBT but not in TAU (PTSS posttreatment: Est. = 0.01, p = .647, 95% CI = -0.29 to 0.47).
This study was the first to investigate the contribution of alliance to outcome among adolescents with posttraumatic symptoms, treated with TF-CBT or TAU. Our findings indicated that there was an important interaction between alliance and therapeutic approach, as alliance predicted outcome in TF-CBT, but not in the nonspecific treatment condition. A positive working relationship appeared to be especially important in the context of this evidence-based treatment, which requires youth involvement in specific therapy tasks. Further, findings showed that use of a manual did not compromise alliance formation.
我们考察了在两种不同治疗条件下（创伤聚焦认知行为疗法[TF-CBT]和常规治疗[TAU]），治疗联盟对受创伤青少年治疗结果的影响。
参与者为156名青少年（平均年龄 = 15.1岁，范围 = 10 - 18岁；79.5%为女孩），随机分配至TF-CBT组或TAU组。在治疗前、治疗中期（第6次治疗）和治疗后（第15次治疗）评估症状。在第1次和第6次治疗后，使用修订后的儿童治疗联盟量表（TASC-R）评估治疗联盟。
不同治疗条件下的治疗联盟得分相当，但TF-CBT组参与者在治疗后的创伤后应激症状（PTSS）显著更低（d = 0.51）。分层回归分析表明，在没有“联盟×治疗组”交互作用的模型中，不存在显著的联盟效应：联盟评分是PTSS降低的显著预测指标（估计值 = -0.53，p = .003，95%置信区间[CI] = -0.87至-0.18），以及TF-CBT中测量但TAU中未测量的其他结果（治疗后PTSS：估计值 = 0.01，p = .647，95% CI = -0.29至0.47）。
本研究首次调查了治疗联盟对接受TF-CBT或TAU治疗的有创伤后症状青少年治疗结果的影响。我们的研究结果表明，联盟与治疗方法之间存在重要的交互作用，因为联盟可预测TF-CBT的治疗结果，但在非特异性治疗条件下则不然。在这种基于证据的治疗背景下，积极的工作关系似乎尤为重要，这种治疗需要青少年参与特定的治疗任务。此外，研究结果表明，使用手册并不会影响联盟的形成。
