Publication year
2016
Citation Title
The working alliance in treatment of military adolescents
Journal Name
Journal of Consulting and Clinical Psychology
Journal Volume
84
Issue Number
3
Page Numbers
200-210
DOI
10.1037/ccp0000035
Summary
Researchers examined the association between working alliance and treatment outcome in a sample of military youth who received psychotherapy for problems related to substance abuse. Participants' ratings on working alliance and treatment outcome were collected during each session. Results supported the change-based model that suggested that adolescents who experienced a growth of alliance over the course of treatment were more likely to achieve better treatment outcomes.
Key Findings
The change-based model (i.e., changes in working alliance scores predicted treatment outcome) best predicted how the growth in working alliance between therapist and client affected the treatment outcome.
On the contrary, the other two models (i.e., one general rating of working alliance score associated with outcome, or an aggregation of working alliance score associated with outcome) could not predict the attribution of working alliance to treatment outcome as well as the change-based model.
Military adolescents who reported an increased in working alliance experienced the best treatment outcomes.
Implications for Program Leaders
Offer education to military children about the importance of seeking professional help when mental health issues occur
Collaborate with mental health professionals to develop opportunities for young people to cultivate skills that would enhance the provider-client relationship
Provide additional prevention/intervention services to military adolescents who may have a substance abuse problem
Implications for Policy Makers
Encourage public awareness campaigns about the substance abuse issues faced by military adolescents
Support training of professionals to pay special attention to nurturing the alliance with youth
Continue dedicating resources to help military adolescents who have substance abuse problems
Methods
The military adolescents were recruited through the counselling services offered by the Adolescent Support and Counselling Services (ASACS).
Participants needed to complete the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) during each session.
The ORS measured the psychological well-being/distress of participants, and the SRS measured client’s perception of quality of the working alliance with the therapist.
Participants
The sample included 2,990 military children who received at least eight psychotherapy sessions for issues related to substance abuse.
Participants ranged in age from 11 to 19 years old (M = 14.91 years, SD = 1.79); 48% of them identified as boys, 52% as girls, and 0.3% did not indicate their gender.
Participants’ race and ethnicity were not specified in the article.
Limitations
The study only used adolescent ratings of the working alliance and outcome, and no ratings from other perspectives were available.
Researchers did not have a standard process to determine the diagnosis of each participant, and there was no control for treatment approach, therefore some confounding factors might influence the results.
The sample was limited to military adolescents who attended therapy for at least eight sessions, so it might be hard to generalize the results to the general population, and to the clients who attended fewer sessions.
Avenues for Future Research
Examine how the association between alliance and outcome is modeled; more specifically, it could focus on a more dynamic and change-oriented view of the rapport to understand the alliance-outcome relationship
Study the characteristics of the therapists whose clients are more likely to experience improvement in working alliance than other therapists’ clients
Utilize standard tests to measure treatment outcomes, and get the alliance data from the therapists’ perspectives
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: Although the working alliance-outcome association is well-established for adults, the working alliance has accounted for 1% of the variance in adolescent therapy outcomes. How the working alliance unfolds in therapy and is modeled in therapy studies may substantially affect how much variance is attributed to the working alliance. Method: The sample included 2,990 military youth who were treated by 98 therapists and attended at least 8 therapy sessions. The average age was 14.91 years (SD = 1.79). Each session, clients completed the Outcome Rating Scale as a measure of psychological well-being/distress and the Session Rating Scale as a measure of working alliance. We utilized 3 models to examine the working alliance-outcome association in therapy: (a) mono-method model (i.e., 1 rating of working alliance correlated with outcomes), (b) aggregate-assessment model (i.e., multiple sessions aggregated and correlated with outcomes), and (c) change-based model (i.e., changes in working alliance scores correlated with outcomes). Results: Findings supported the change-based model. The amount of variance explained in youth outcomes via growth in working alliance scores in the change-based model was approximately 9.8%, which suggests that a key mechanism of client-perceived change for adolescents in therapy may be the continual development of the working alliance over the course of treatment. Conclusions: The monitoring of and continual promotion of the working alliance among military youth in the early phases of therapy may help therapists improve treatment outcomes.
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