Accurso Erin C, Garland Ann F
Department of Psychiatry and Behavioral Neuroscience, The University of Chicago.
Department of School, Family and Mental Health Professions, University of San Diego.
Psychol Assess. 2015 Mar;27(1):347-52. doi: 10.1037/pas0000031. Epub 2014 Oct 13.
This study examined the temporal stability and cross-informant agreement on multiple perspectives of child and caregiver alliance with therapists in usual care psychotherapy. Baseline predictors of alliance were also examined. Children with disruptive behavior problems (n = 209) and their caregivers were followed for up to 16 months after initiating psychotherapy at a community-based clinic. Alliance was rated by children, caregivers, and therapists every 4 months for as long as families participated in treatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine whether child and caregiver alliance differed across time, as well to examine factors associated with each perspective on alliance. Intraclass correlations between child, caregiver, and therapist reports of alliance were also examined. Alliance was rated relatively high overall across perspectives. Clients (children and caregivers) tended to report the strongest and most stable alliance, while therapists reported the weakest alliance and perceived deteriorations in child alliance over time. Inter-informant agreement was variable for child and caregiver alliance; agreement was moderate between clients and therapists. Several predictors of alliance emerged, including child gender, anxiety diagnosis, caregiver race/ethnicity, and therapist experience. This study provides methodological information about reports of therapeutic alliance across time and informants that can inform current efforts to understand the alliance-outcome association.
本研究考察了在常规护理心理治疗中，儿童与照顾者和治疗师之间联盟的多个视角的时间稳定性和不同信息提供者之间的一致性。还对联盟的基线预测因素进行了考察。患有破坏性行为问题的儿童（n = 209）及其照顾者在社区诊所开始心理治疗后随访长达16个月。只要家庭参与治疗，每4个月由儿童、照顾者和治疗师对联盟进行评分。使用具有随机截距的线性混合模型进行重复测量分析，以确定儿童和照顾者的联盟是否随时间而不同，并考察与联盟各视角相关的因素。还考察了儿童、照顾者和治疗师对联盟报告的组内相关性。从各视角来看，联盟总体评分相对较高。服务对象（儿童和照顾者）往往报告联盟最强且最稳定，而治疗师报告的联盟最弱，并认为儿童联盟会随时间恶化。儿童和照顾者联盟的不同信息提供者之间的一致性存在差异；服务对象与治疗师之间的一致性为中等。出现了几个联盟的预测因素，包括儿童性别、焦虑诊断、照顾者种族/族裔和治疗师经验。本研究提供了关于治疗联盟随时间和信息提供者报告的方法学信息，可为当前理解联盟与治疗结果关联的努力提供参考。
