Ormhaug Silje M, Shirk Stephen R, Wentzel-Larsen Tore
Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.
Department of Psychology, University of Oslo, Oslo, Norway;
Eur J Psychotraumatol. 2015 Aug 31;6:27705. doi: 10.3402/ejpt.v6.27705. eCollection 2015.
Client ratings of the therapeutic alliance are an important predictor of outcome in the treatment of traumatized adolescents and adults, but less is known about the therapists' perspective. The aim of this study was to investigate how therapists' ratings relate to the adolescents' perspective, how individual therapist and adolescent ratings relate to change in symptoms and treatment satisfaction, and whether discrepant alliance perspectives impact treatment outcome.
The sample consisted of 156 youth (mean age 15.1, range 10-18), randomized to trauma-focused cognitive behavioral therapy or treatment as usual, and alliance ratings from 62 therapists. Alliance was measured midtreatment with the Therapeutic Alliance Scale for Children, and the factor structure of the two scales was analyzed with exploratory factor analyses. A change in posttraumatic symptoms was assessed with the Child PTSD Symptom Scale (CPSS) and the Clinicial-Administered PTSD Scale for Children and Adolescents (CAPS-CA).
Therapist and client perspectives on the alliance were significantly, but moderately, associated (intraclass correlations [ICC]=0.54, p<0.001). Both scales predicted adolescent treatment satisfaction but only the client scale was significantly related to change in symptoms. Factor analyses revealed differences in factor structure with therapist ratings organized around bond and task dimensions and adolescent ratings organized by item valence. Higher therapist ratings compared to adolescent ratings predicted higher residual PTS symptoms.
Although adolescent and therapist alliance ratings are moderately associated, results suggest that the ratings are differentially associated with outcomes. These findings, along with results indicating important differences in factor structure, imply that adolescent and therapist ratings are not interchangeable. Future studies should investigate how therapists can improve their judgments of adolescents' perceptions of the alliance as an overestimation of the quality of the relationship seems to be negatively related to outcome.
来访者对治疗联盟的评分是受创伤青少年和成年人治疗效果的重要预测指标，但对于治疗师的观点了解较少。本研究的目的是调查治疗师的评分与青少年的观点之间的关系，个体治疗师和青少年的评分与症状变化及治疗满意度之间的关系，以及联盟观点的差异是否会影响治疗效果。
样本包括156名青少年（平均年龄15.1岁，范围10 - 18岁），他们被随机分配接受创伤聚焦认知行为疗法或常规治疗，以及来自62名治疗师的联盟评分。在治疗中期使用儿童治疗联盟量表测量联盟情况，并通过探索性因素分析对两个量表的因素结构进行分析。使用儿童创伤后应激障碍症状量表（CPSS）和儿童青少年临床管理创伤后应激障碍量表（CAPS - CA）评估创伤后症状的变化。
治疗师和来访者对联盟的观点显著但中等程度相关（组内相关系数[ICC]=0.54，p<0.001）。两个量表都预测了青少年的治疗满意度，但只有来访者量表与症状变化显著相关。因素分析揭示了因素结构的差异，治疗师的评分围绕关系和任务维度组织，而来访者的评分按项目效价组织。与青少年评分相比，治疗师评分较高预示着更高的残留创伤后应激症状。
尽管青少年和治疗师的联盟评分中等程度相关，但结果表明这些评分与治疗效果的关联存在差异。这些发现，连同表明因素结构存在重要差异的结果，意味着青少年和治疗师的评分不可互换。未来的研究应调查治疗师如何改善他们对青少年对联盟看法的判断，因为对关系质量的高估似乎与治疗效果呈负相关。
