Parnassia Addiction Research Center (PARC), Brijder Addiction Care, Zoutkeetsingel 40, 2512 HN, The Hague, The Netherlands.
Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University Medical Center, Leiden, The Netherlands.
Eur Child Adolesc Psychiatry. 2020 Nov;29(11):1593-1601. doi: 10.1007/s00787-020-01503-w. Epub 2020 Mar 10.
We investigated the potential role of first-session therapeutic alliance ratings to serve as an early marker of treatment outcome in youth mental health and addiction treatment. The present study is among the first to incorporate both a youths' and a therapists' perspective of the therapeutic alliance in order to maximize predictive value of the alliance for treatment outcome. One hundred and twenty-seven adolescents participated in a multi-site prospective naturalistic clinical cohort study, with assessments at baseline and at 4 months post-baseline. Main outcome measure was favorable or unfavorable treatment outcome status at 4-month follow-up. Early therapeutic alliance had a medium and robust association with treatment outcome for youth' (b = 1.29) and therapist' (b = 1.12) perspectives and treatment setting. Based on the two alliance perspectives four subgroups were distinguished. Incorporating the alliance-ratings from both perspectives provided a stronger predictor of treatment outcome than using one perspective. Youth with a strong alliance according to both perspectives had an eightfold odds of favorable treatment outcome compared with youth with a weak alliance according to both perspectives. The association between therapeutic alliance and treatment outcome in youth mental health and addiction treatment may be substantially stronger than earlier assumed when both a youths' and therapists' perspective on alliance is considered.
我们研究了首次治疗联盟评估作为青少年心理健康和成瘾治疗结果的早期标志物的潜在作用。本研究首次将青少年和治疗师对治疗联盟的看法结合起来，以最大限度地提高联盟对治疗结果的预测价值。127 名青少年参加了一项多地点前瞻性自然临床队列研究，在基线和基线后 4 个月进行评估。主要结果指标是 4 个月随访时的治疗结果是否有利或不利。早期治疗联盟与青少年（b=1.29）和治疗师（b=1.12）的治疗结果以及治疗环境有中等且强大的关联。基于两个联盟视角，区分了四个亚组。结合两个视角的联盟评估比使用一个视角提供了更强的治疗结果预测。与两个视角均显示弱联盟的青少年相比，两个视角均显示强联盟的青少年治疗结果良好的可能性是其八倍。当考虑到青少年和治疗师对联盟的看法时，治疗联盟与青少年心理健康和成瘾治疗结果之间的关联可能比之前假设的要强得多。
