Predictors of child-therapist alliance in cognitive-behavioral treatment of children referred for oppositional and antisocial behavior.

We examined the therapeutic alliance in evidence-based treatment for children (N=97, 24 girls and 73 boys, ages 6-13 years) referred clinically for oppositional, aggressive, and antisocial behavior. We predicted that the quality of the child-therapist alliance would be related to therapeutic improvements in the children at the end of treatment and that the alliance would be predicted by alliance-relevant child characteristics (intellectual and social competencies) assessed before treatment. Multiple perspectives were obtained to evaluate child characteristics before treatment, alliance during the course of treatment, and therapeutic change at the end of treatment. The main findings were as follows: (1) the child-therapist alliance was related to therapeutic change at the end of treatment. The better the quality of the therapeutic alliance during treatment, the greater the therapeutic change among the children; (2) intellectual and social competencies of the child before treatment predicted the quality of the therapeutic alliance. Children higher in intellectual and social competencies formed a better child-therapist alliance; and (3) intellectual and social competencies did not account for or explain the connection of alliance and therapeutic change. The findings could not easily be attributed to the influence of other domains (socioeconomic disadvantage, parent psychopathology and stress, and severity and scope of child dysfunction) that plausibly might contribute to alliance and therapeutic change or to rater effects (common rater variance) among predictors and outcome criteria. We propose that the next steps for child-alliance research is to better describe factors that contribute to alliance and to explain precisely what mechanisms might be involved that connect alliance during treatment with changes in individual functioning.