The study suggests that adherence to attachment-based family therapy interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist.
Authors
Maliha Ibrahim, Post-doctoral Research Consultant, Sangath Foundation, New Delhi (Currently, Assistant Professor, Jindal School of Psychology & Counselling, O.P. Jindal Global University, Sonipat, Haryana, India.)
Suzanne Levy, Clinical Director, Center for Family Intervention Science, Drexel University, Philadelphia, Pennsylvania, USA.
Bob Gallop, Professor of Biostatistics, University of West Chester, Philadelphia, Pennsylvania, USA.
Stephanie Krauthamer Ewing, Assistant Professor, Counseling and Family Therapy Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
Aaron Hogue, Director of Adolescent and Family Research, Center on Addiction, New York, USA.
Jessica Chou, Assistant Professor, Counseling and Family Therapy Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
Guy Diamond, Director, Center for Family Intervention Science, Drexel University, Philadelphia, Pennsylvania, USA.
Summary
In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance.
The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment-based family therapy (ABFT) with family-enhanced nondirective supportive therapy (FE-NST). Recordings were selected from early, middle, and late stages of treatment.
The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self-report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid-treatment but not at posttreatment. Adherence to FE-NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE-NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.
Published in: Wiley Online Library
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