The DOI matches its Crossref record; 92 of the 92 references it cites were found in a registry or an index.
Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy
Abstract
In the youth treatment literature, the alliance has been defined and measured as a consensual or collaborative bond. In this article, we review varied definitions of the alliance, enumerate its frequent measures, and present clinical examples. We provide a meta-analytic review on the relation between the therapeutic alliance and treatment outcome in child and adolescent psychotherapy. In particular, this review only includes prospective studies of youth therapy that used an explicit measure of alliance. The meta-analysis of 28 studies revealed a weighted random effect size of r = .19 (k = 28, N = 2419, p < .01, 95% confidence interval [.13, .25]), which is a small to medium effect (equivalent to d = 0.39) consistent with the adult alliance literature and with prior youth meta-analyses. Given that a medium-large amount of heterogeneity was observed in effect sizes (I2 = 64.19%), theory- and method-based moderators were examined. Multiple moderators of the alliance-outcome association were found, including diagnosis class, type of therapy, study design (randomized controlled trials [RCT] vs. nonrandomized trials [non-RCT]), and treatment setting (inpatient vs. outpatient). Research limitations, patient contributions, and diversity considerations follow. The article concludes with research-informed practices for building and maintaining the therapeutic alliance with youth. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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“Alliance is another well-studied mechanism of change that has consistently shown a moderate association with outcomes in face-to-face therapy in both adults and youths (Flückiger et al., 2018; Karver et al., 2018).”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Karver et al., 2018
In the citing paper
“This contrasts with the predictive value of a positive alliance in face-to-face treatments (Flückiger et al., 2018; Karver et al., 2018), but aligns with prior research on alliance in ICBT for adults.”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Karver et al., 2018
In the citing paper
“Previous research has found that the TA generally has moderate but reliable correlations with clinical outcomes across all types of mental health problems and treatment approaches in both young people and adults (25–27).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [26]
In the citing paper
“These mixed findings are inconsistent with findings from face-to-face therapy (25–27).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [26]
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Metadata
- Authors
- Karver, M. S., De Nadai, A. S., Monahan, M., & Shirk, S. R.
- Affiliations
- University of South Florida (US)
- University of Denver (US)
- Venue
- Psychotherapy
- Published
- 2018-12
- Volume
- 55
- Issue
- 4
- Pages
- 341-355
- ISSN
- 0033-3204 (ISSN-L)
- 1939-1536
- OpenAlex
- W2898018055
- Cited by
- 234
- References
- 92
- Citations by year
- 2026: 37 · 2025: 32 · 2024: 36 · 2023: 36 · 2022: 38 · 2021: 24 · 2020: 23 · 2019: 6 · 2018: 2
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Counseling Practices and Supervision
- Keywords
- therapeutic relationship, child and adolescent psychotherapy, treatment outcomes, randomized controlled trials, inpatient vs outpatient treatment
- MeSH terms
- Therapeutic Alliance, Adolescent, Mental Disorders, Child, Cooperative Behavior, Humans, Prospective Studies, Psychotherapy, Treatment Outcome
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