The Working Alliance in Treatment of Military Adolescents

• Published in: Journal of consulting and clinical psychology 2016-03, Vol.84 (3), p.200-210
• Main Authors: Owen, Jesse, Miller, Scott D, Seidel, Jason, Chow, Daryl
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Development; Adolescents; Change agents; Child; Client relationships; Clinical outcomes; Cognitive therapy; Female; Human; Humans; Male; Military Families; Military Personnel; Professional associations; Professional-Patient Relations; Promotion; Psychological distress; Psychological well being; Psychotherapy; Psychotherapy - methods; Substance-Related Disorders - psychology; Substance-Related Disorders - therapy; Teenagers; Therapeutic Alliance; Therapeutic alliances; Therapists; Treatment Outcome; Treatment Outcomes; Variance analysis; Well being; Young Adult
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000035

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. What is the public health significance of this article? This study strongly suggests that growth in the working alliance in the initial sessions of treatment with adolescents is a positive indicator of therapy outcomes. Accordingly, therapists could benefit from monitoring the working alliance and work to improve their ability to foster high quality working alliances across treatment.