Associations between Therapeutic Alliance and Treatment Outcomes in an Intervention for Children with Externalizing Behavior and Mild to Borderline Intellectual Disabilities
Esch, J.J.E. van
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The quality of the alliance between client and therapist is suggested to be a critical factor in explaining treatment outcomes in both adult and child psychotherapy. This study examines associations between the therapeutic alliance (TA) and the effectiveness of Standing Strong Together (SST), a group-based parent and child intervention for children with mild to borderline intellectual disabilities (MBID; IQ 55-85) and externalizing behavior. A repeated measures design is used to assess externalizing behavior, positive parenting and the parent-child relationship before and after treatment (N = 97). Audio-recordings of mid-treatment sessions were analyzed to examine the TA quality. In the current study, children in families with a high TA quality showed greater reductions in externalizing behavior, reported by their parents, than did children in families with a low TA quality. The child-therapist alliance individually predicted externalizing behavior reductions, while the parent-therapist alliance did not. Therapeutic alliance quality was not associated with SST outcomes in terms of positive parenting and the parent-child relationship. Findings of the current study demonstrate that a high quality of therapeutic alliance in Standing Strong Together is associated with a stronger decrease of externalizing behavior in children with MBID.