Abstract:
Background: Caregivers play a key role in the success of trauma-focused cognitive behavioural therapy (TF-CBT). Yet, the effect of their alliance on treatment outcomes besides the
other parties in treatment has hardly been studied.
Objective: This study examined the working alliance (WA) of therapists, patients and
caregivers in TF-CBT and its contribution on treatment outcome over time.
Methods: N = 76 children and adolescents (mean age = 12.66 years, range 7–17, M/F ratio: .43)
participated in the TF-CBT arm of a randomized controlled trial. The WA was assessed with the
Working Alliance Inventory Short Version (WAI-S) at two measurement points, while symptom
level of posttraumatic stress symptoms (PTSS) was assessed with the Clinician-Administered
PTSD Scale for Children and Adolescents (CAPS-CA). Paired sample t-tests, intraclass correlations
(ICC), and mixed-effects regression models for longitudinal data were performed.
Results: The alliance rating was high across all informants, with caregivers achieving the
highest rating. The average level of cross-informant agreement on the alliance was low
between therapists and caregivers (ICC = .26) and moderate between therapists and
patients (ICC =.65). A significant contribution of an alliance improvement to the reduction
of PTSS over time was found in each of the two tested models: therapists with patients
model (b = .682) and therapists with caregivers model (b = .807). However, these effects
were not detected with all four perspectives in one comprehensive model.
Conclusion: In summary, the potential of caregivers’ views should receive more attention in
the therapeutic process of trauma-focused therapy.