Research papersThe therapeutic alliance in the cognitive behavioral treatment of pediatric obsessive–compulsive disorder☆
Section snippets
Participants
Twenty-five youth aged 7–17 years (M = 13.16, SD = 2.69) with a principal diagnosis of OCD and their parents participated in the current study. Participants (11 females) were recruited from families who presented to a specialty OCD Clinic. Eighty percent of the sample was Caucasian, 8% was African American, 8% was Hispanic, and 4% was biracial. The average age of OCD onset for the sample was 10.48 years of age. Inclusion criteria were as follows: (a) principal diagnosis of OCD based on the Anxiety
Sample characteristics
Means, standard deviations, and ranges for each study measure are presented in Table 1. As can be seen in Table 3, scores on the CY-BOCS were reduced across treatment, with an overall Cohen's d effect size of 2.89. Fifty-nine percent of the current study's sample achieved remission status (CY-BOCS < 10) which was measured immediately following the last treatment session. All measures demonstrated acceptable internal consistency; alpha coefficients ranged from .70 to .98. Independent group t-tests
Discussion
The primary aim of the current study was to examine the role of the TA in CBT for pediatric OCD. We found that both child-rated and therapist-rated child–therapist TAs were significantly related to treatment outcome, such that stronger ratings of the alliance at the beginning of treatment and at mid-treatment predicted a greater reduction in OCD symptoms at post-treatment. Additionally, results indicated that both the parent-rated and the therapist-rated parent–therapist TA was also a
References (68)
- et al.
The effectiveness of treatment for pediatric obsessive–compulsive disorder: a meta-analysis
Behavior Therapy
(2005) - et al.
Cognitive-behavioral family treatment of childhood obsessive–compulsive disorder: long-term follow-up and predictors of outcome
Journal of the American Academy of Child and Adolescent Psychiatry
(2005) - et al.
Cognitive-behavioral family treatment of childhood obsessive–compulsive disorder: a controlled trial
Journal of the American Academy of Child and Adolescent Psychiatry
(2004) Effective treatment of OCD?
Journal of the American Academy of Child and Adolescent Psychiatry
(2006)- et al.
Obsessive compulsive disorder in a birth cohort of 18 year olds: prevalence and predictors
Journal of the American Academy of Child and Adolescent Psychiatry
(1995) - et al.
Is juvenile obsessive–compulsive disorder a developmental subtype of the disorder? A review of the pediatric literature
Journal of the American Academy of Child and Adolescent Psychiatry
(1998) - et al.
Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature
Clinical Psychology Review
(2006) - et al.
Clinical predictors of response to cognitive-behavioral therapy for obsessive–compulsive disorder
Clinical Psychology Review
(2008) Cognitive behavioral therapy of childhood OCD
Child and Adolescent Psychiatric Clinics of North America
(1999)- et al.
Open trial of cognitive behavior therapy for childhood obsessive–compulsive disorder
Journal of Anxiety Disorders
(2002)
Children's Yale–Brown Obsessive Compulsive Scale: reliability and validity
Journal of the American Academy of Child and Adolescent Psychiatry
Cognitive-behavioral therapy for pediatric obsessive–compulsive disorder: comparison of intensive and weekly approaches
Journal of the American Academy of Child and Adolescent Psychiatry
Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive–compulsive disorder
Journal of the American Academy of Child and Adolescent Psychiatry
Cognitive-behavioral therapy for PANDAS-related obsessive–compulsive disorder: findings from a preliminary waitlist controlled open trial
Journal of the American Academy of Child and Adolescent Psychiatry
Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD
Journal of Behavior Therapy and Experimental Psychiatry
Treatment of obsessive–compulsive disorder: cognitive behavior therapy vs. exposure and response prevention
Behaviour Research and Therapy
The epidemiology of obsessive–compulsive disorder in children and adolescents
Child and Adolescent Psychiatric Clinics of North America
Treatment compliance and outcome in obsessive–compulsive disorder
Behavior Modification
Practice parameters for the assessment and treatment of children and adolescents with obsessive–compulsive disorder
Journal of the American Academy of Child and Adolescent Psychiatry
Diagnostic and statistical manual of mental disorders—fourth edition—text revision
Family treatment of childhood anxiety: a controlled trial
Journal of Consulting and Clinical Psychology
Longitudinal assessment of symptom and subtype categories in obsessive–compulsive disorder
Depression and Anxiety
Statistical power analysis for the behavioral sciences
Therapist alliance-building behavior within a cognitive-behavioral treatment for anxiety in youth
Journal of Consulting and Clinical Psychology
Early compliance and other factors predicting outcome of exposure for obsessive–compulsive disorder
British Journal of Psychiatry
The therapeutic relationship in child therapy: perspectives of children and mothers
Journal of Clinical Child and Adolescent Psychology
The therapist–parent alliance in family-based therapy for adolescents
Journal of Clinical Psychology
The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression
Journal of Consulting and Clinical Psychology
Role of the working alliance in the treatment of delinquent boys in community-based programs
Journal of Clinical Child Psychology
Psychotherapies for obsessive–compulsive disorder: a review
Emotional processing of fear: exposure to corrective information
Psychological Bulletin
Family-based treatment of early-onset obsessive–compulsive disorder
Journal of Child and Adolescent Psychopharmacology
When youth mental health car stops: therapeutic relationship problems and other reasons for ending youth outpatient treatment
Journal of Consulting and Clinical Psychology
Annotation: the therapeutic alliance—a significant but neglected variable in child mental health treatment studies
Journal of Child Psychology and Psychiatry
Cited by (44)
Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: A mixed methods study and analysis plan for the TECTO trial
2023, Contemporary Clinical Trials CommunicationsTherapist- and therapy-related predictors of outcomes in a randomized controlled trial of school-based treatments for pediatric anxiety
2022, Journal of Behavioral and Cognitive TherapyCitation Excerpt :The impact of therapeutic alliance on treatment outcomes for youth with anxiety is mixed in the literature. Some studies have found an association between alliance and outcomes for this population (Hughes & Kendall, 2007; Keeley, Geffken, Rickets, & McNamara, 2011), and there is some evidence that improvements in therapeutic alliance have a positive impact on outcomes (Chiu, McLeod, Har, & Wood, 2009; Hudson et al., 2014). Reciprocal relationships between alliance and reductions in anxiety are likely, with early measurements of alliance predicting later outcomes, and reductions in anxiety symptoms resulting in improved therapeutic alliance (Marker, Comer, Abramova, & Kendall, 2013).
Addressing Common Myths and Mistaken Beliefs in the Treatment of Youth With OCD
2017, The Clinician's Guide to Cognitive-Behavioral Therapy for Childhood Obsessive-Compulsive DisorderIntervention Format and Therapist–Child Agreement Associated With Therapeutic Alliance and Outcomes
2023, Journal of Consulting and Clinical PsychologyA Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy
2023, Research on Child and Adolescent Psychopathology
- ☆
Author note: Portions of this paper were supported by grants from the Society of Clinical Child and Adolescent Psychology (Division 53 of the American Psychological Association) to the first author.