The Relationship between Alliance, Attachment and Outcome in a Child Multi-Modal Treatment Population: Pilot Study.

OBJECTIVES This pilot study explored the relationship between parental therapeutic alliance, maternal attachment style and child and family functioning in a sample of families with a child aged five to twelve years receiving child psychiatry day hospital treatment for complex co-morbid disorders. METHOD Self-report measures of therapeutic alliance, maternal attachment style, child behaviour and family functioning were administered to parents at the end of the assessment period (T1) and at discharge (T2). The original study cohort included 90 families, and 44 families completed all the study measures at T2. Correlational analysis was conducted on these 44 families measuring parental alliance, maternal attachment style with child and family functioning scores. Comparisons were made between participants that completed T1 and T2 of the study with participants that only completed T1. RESULTS For the 44 families who completed both T1 and T2 measures, the combination of secure maternal attachment style and positive therapeutic alliance at T1 was associated with positive child outcomes, that is, improved scores on both the internalizing and externalizing dimensions as measured by the CBCL between T1 and T2. Significant changes were identified in family functioning with improvement on cohesion and expressiveness, enhanced intellectual-cultural orientation and improved family organization as measured by the FES. CONCLUSIONS Capacity for secure attachment and positive alliance are associated with improved child and family systems outcomes in a high risk cohort of children with co-morbid disorders from a day and evening multimodal family treatment program.