Child Involvement and Therapist Alliance-Building Behavior: In-session Behavior during Alliance Ruptures within Cognitive-Behaveriol Therapy for Anxious Children

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Therapeutic alliance ruptures, short deteriorations of the quality of therapeutic alliance, are linked to positive as well as negative treatment outcomes. However, research on alliance ruptures within child psychotherapy is scarce. This study investigated the occurrence and accordance of children’s and therapists’ alliance ruptures, as well as children’s and therapists’ in-session behaviour during treatment sessions identified as ruptures. Participants were 89 clinically anxious children (aged 7-13 years), receiving cognitive-behavioral therapy by 19 therapists. Therapeutic alliance of children and therapists was assessed for treatment sessions using alliance questionnaires (TASC and WAI-T, respectively), yielding individual alliance time series of children and therapists. Tukey’s Control Charts were applied to determine alliance ruptures. In-session behavior was obtained by coding audio recordings of sessions characterized as alliance ruptures, using the Child Involvement Rating Scale-Revised and the Therapist Alliance-Building Behavior Scale. Alliance ruptures were found within 18.6% of children’s alliance time series and 32.1% of therapists’ alliance time series. No accordance between children’s and therapists’ ruptures was found. Unexpectedly, child involvement (CI) and therapists alliance-building behavior (TABB) did not followed alliance patterns during children’s alliance ruptures sequences. Partial resemblance of CI and TABB with alliance patterns during therapists’ alliance rupture sequences was found. The findings suggest that children’s and therapists’ perception of alliance ruptures differ. Moreover, CI and TABB seem to representat therapists’ alliance ruptures, however do not represent children’s alliance ruptures.
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