The therapeutic alliance in treatment of traumatized youths: Relation to outcome in a randomized clinical trial.

Ormhaug, Silje M.; Jensen, Tine K.; Wentzel-Larsen, Tore; Shirk, Stephen R.

doi:10.1037/a0033884

Cited by 113Psychotherapy Techniques and ApplicationsPosttraumatic Stress Disorder ResearchPsychoanalysis and Psychopathology Research

The therapeutic alliance in treatment of traumatized youths: Relation to outcome in a randomized clinical trial.

Ormhaug, Silje M., Jensen, Tine K., Wentzel-Larsen, Tore, Shirk, Stephen R.·2014·Journal of Consulting and Clinical Psychology

DOI 10.1037/a0033884

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Abstract

OBJECTIVE: We examined the contribution of alliance to the outcome of therapy with traumatized youths across two different treatment conditions (trauma-focused cognitive behavioral therapy [TF-CBT] and therapy as usual [TAU]). METHOD: Participants were 156 youths (M age = 15.1 years, range = 10-18; 79.5% girls), randomly assigned to TF-CBT or TAU. Symptoms were assessed pretreatment, midtreatment (Session 6), and posttreatment (Session 15). Alliance was assessed after Sessions 1 and 6, using the Therapeutic Alliance Scale for Children-Revised (TASC-R). RESULTS: Alliance scores were comparable across treatment conditions, but TF-CBT participants had significantly lower posttraumatic stress symptoms (PTSS) posttreatment (d = 0.51). Hierarchical regression analyses showed that there were no significant alliance effects in models without an Alliance × Treatment Group interaction: Alliance ratings were significant predictors of reduction in PTSS (Est. = -0.53, p = .003, 95% confidence interval [CI] = -0.87 to -0.18) and additional outcomes measured in TF-CBT but not in TAU (PTSS posttreatment: Est. = 0.01, p = .647, 95% CI = -0.29 to 0.47). CONCLUSION: This study was the first to investigate the contribution of alliance to outcome among adolescents with posttraumatic symptoms, treated with TF-CBT or TAU. Our findings indicated that there was an important interaction between alliance and therapeutic approach, as alliance predicted outcome in TF-CBT, but not in the nonspecific treatment condition. A positive working relationship appeared to be especially important in the context of this evidence-based treatment, which requires youth involvement in specific therapy tasks. Further, findings showed that use of a manual did not compromise alliance formation.

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Strength of therapeutic alliance is an important and consistent predictor of treatment success.
“Strength of therapeutic alliance, defined as the affective bond between the therapist and patient, is an important and consistent predictor of treatment success (Ormhaug et al, 2014)”
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Predicting frequency of treatment visits in community-based youth psychotherapy.
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Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy
Karver, M. S., De Nadai, A. S., Monahan, M., & Shirk, S. R. (2018) · Psychotherapy · doi:10.1037/pst0000176 · Cited by 234 · see citing works
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Psychological therapies for children and adolescents exposed to trauma
Gillies, D., Maiocchi, L., Bhandari, A. P., Taylor, F., Gray, C., & O'Brien, L. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012371 · Cited by 143 · see citing works
Trauma-focused cognitive behavioral therapy for children and families
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Meta-Analysis of Trauma-Focused Cognitive Behavioral Therapy for Treating PTSD and Co-occurring Depression Among Children and Adolescents
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Anger and aggression in PTSD
Taft, C. T., Creech, S. K., & Murphy, C. M. (2016) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2016.11.008 · Cited by 102 · see citing works
Practitioner Review: Therapist variability, patient‐reported therapeutic alliance, and clinical outcomes in adolescents undergoing mental health treatment – a systematic review and meta‐analysis
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Intranasal oxytocin administration dampens amygdala reactivity towards emotional faces in male and female PTSD patients
Koch, S. B., van Zuiden, M., Nawijn, L., Frijling, J. L., Veltman, D. J., & Olff, M. (2016) · Neuropsychopharmacology · doi:10.1038/npp.2015.299 · Cited by 98 · see citing works
Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis
Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., & O’Toole, S. K. (2018) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-018-0212-1 · Cited by 96 · see citing works
Child, caregiver, and therapist perspectives on therapeutic alliance in usual care child psychotherapy.
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Clinicians’ perspectives of therapeutic alliance in face-to-face and telepractice speech–language pathology sessions
Freckmann, A., Hines, M., & Lincoln, M. (2017) · International Journal of Speech-Language Pathology · doi:10.1080/17549507.2017.1292547 · Cited by 77 · see citing works
A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents
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Self-citation

Authors: Ormhaug, S. M., Jensen, T. K., Wentzel-Larsen, T., & Shirk, S. R.
Affiliations: Norwegian Centre for Violence and Traumatic Stress Studies (NO)
University of Oslo (NO)
University of Denver (US)
ORCID: Ormhaug, Silje M.
Jensen, Tine K.
Venue: Journal of Consulting and Clinical Psychology
Publisher: American Psychological Association (APA)
Published: 2014
Volume: 82
Issue: 1
Pages: 52-64
ISSN: 0022-006X (ISSN-L)
1939-2117
DOI: 10.1037/a0033884
OpenAlex: W2113548391
Semantic Scholar: af03fc4077368229543ead30e2b7531dab592738
Cited by: 113
References: 177
Citations by year: 2026: 4 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 12 · 2021: 21 · 2020: 8 · 2019: 5 · 2018: 13 · 2017: 9 · 2016: 9 · 2015: 9 · 2014: 2 · 2013: 3
FWCI: 8.52
Type: journal article
Language: en
Open access: closed
Locations: Journal of Consulting and Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: therapeutic relationship, trauma-focused cognitive behavioral therapy, posttraumatic stress symptoms, treatment outcomes, nonspecific therapy, manualized treatment, workplace relationships
MeSH terms: Adolescent, Child, Female, Humans, Male, Professional-Patient Relations, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome

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The therapeutic alliance in treatment of traumatized youths: Relation to outcome in a randomized clinical trial.

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