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OBJECTIVES: The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA. METHODS: The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q). RESULTS: Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients). CONCLUSION: We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.
Assuntos
Aliança Terapêutica , Criança , Humanos , Relações Profissional-Paciente , Psicoterapeutas , Psicoterapia/métodos , Resultado do Tratamento , Masculino , FemininoRESUMO
Introduction: Routine Outcome Monitoring (ROM) has emerged as a strong candidate to improve psychotherapy processes and outcome. However, its use and implementation are greatly understudied in Latin-America. Therefore, the aim of the present pilot study conducted in Argentina was to implement a ROM and feedback system grounded on a psychometrically sound instrument to measure session by session outcome in psychotherapy. Methods: The sample consisted of 40 patients and 13 therapists. At baseline, the patients completed the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, and they also completed the Hopkins Symptom Checklist-11 before each of the first five sessions. To estimate patient change during the first sessions, we conducted a quantitative analysis using Hierarchical Linear Models. Furthermore, we conducted a qualitative analysis using Consensual Qualitative Research to analyze therapist perception regarding the ROM and feedback system. Results: Results showed a significant reduction in patients' symptomatic severity during the first five sessions. Additionally, baseline depression significantly predicted the estimated severity at the end of the fifth session. Feedback was given to the therapists after the first four sessions based on these analyses. With regard to the perception of the feedback system, clinicians underlined its usefulness and user-friendly nature. They also mentioned that there was a match between the information provided and their clinical judgment. Furthermore, they provided suggestions to enhance the system that was incorporated in a new and improved version. Discussion: Limitations and clinical implications are discussed.
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Resumen La investigación a partir de la perspectiva del paciente ha brindado información importante acerca de cómo la terapia es percibida, ayudando a los terapeutas a entender algunas reacciones desde los pacientes. Debido a las pocas investigaciones de este tipo en la población infantil, la terapia con niños no ha sido beneficiada por este movimiento. El presente trabajo es de carácter empírico con un enfoque de análisis cualitativo. En este estudio se exploraron las percepciones de los niños sobre distintos elementos del proceso psicoterapéutico. Para esto, se realizaron entrevistas semiestructuradas a 10 niños entre 6 y 12 años que se encontraban realizando tratamiento psicoterapéutico, o lo habían realizado en el último año. Durante las entrevistas se indagó sobre la "relación terapéutica", las "intervenciones del terapeuta", la "valoración de la terapia", las "nociones sobre la terapia", las "características de la terapia" y el "cambio percibido". Se analizaron las entrevistas bajo una metodología cualitativa consensual (CQR). Los resultados indican que los niños percibieron cambios vinculados a su propia conducta, emociones y relaciones interpersonales y pudieron relacionarlos con sus terapeutas y la alianza establecida con ellos.
Abstract Research from the patients' perspective has provided valuable information about how the psychotherapy process is perceived, helping therapists to understand some of the patient's reactions. Due to the limited research of this type in the children population, therapy with children has not benefited from this movement. The present study is an empirical work framed in a qualitative analysis approach, in which we inquired about children's perceptions about different elements related to the psychotherapeutic process. For this purpose, we conducted semi-structured interviews with 10 children between 6 and 12 years old, who were undergoing a psychotherapeutic treatment or had done it in the last year. During the interviews, we inquired about elements such as "therapeutic relationship," "therapist interventions," "therapy assessments," "notions about therapy," "therapy characteristics," and "perceived change." The interviews were analyzed using a consensual qualitative methodology (CQR). The results indicate that children were able to perceive changes concerning their behavior, emotions, and interpersonal relationships and could link these changes with their therapists and the therapeutic alliance established with them.