Skip to main content
SpringerLink
Log in

Therapeutic Alliance, Perceived Treatment Barriers, and Therapeutic Change in the Treatment of Children with Conduct Problems

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

We examined two emergent processes in treatment (parent-therapist alliance and perceived barriers to treatment participation) in parent management training for children (N = 234, 55 girls and 179 boys, ages 4–14) referred clinically for oppositional, aggressive, and antisocial behavior. We predicted that two parent characteristics (interpersonal relationships and quality of daily life) evaluated prior to treatment would predict quality of the therapeutic alliance and perceived barriers during treatment. Alliance and perceived barriers were significantly related to treatment outcome. Stronger alliance and fewer perceived barriers were associated with greater therapeutic change. Interpersonal relationships and quality of daily life, each represented with multiple measures, predicted quality of the therapeutic alliance and perceived barriers during treatment. Alliance and barriers continued to predict therapeutic change even after controlling for pretreatment predictors of these emergent processes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abidin, R. R. (1995). Parenting Stress Index: manual (3rd ed.). Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychological Association (2015). Stress in America: Paying with our health. Washington, DC: American Psychological Association.

    Google Scholar 

  • Aneshensel, C. S., & Stone, J. D. (1982). Stress and depression: A test of the buffering model of social support. Archives of General Psychiatry, 39, 1392–1396.

    Article  PubMed  Google Scholar 

  • Busby, D. M., Christensen, C., Crane, D. R., & Larson, J. H. (1995). A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy, 21(3), 289–308.

    Article  Google Scholar 

  • Caughter, S., & Dunsmuir, S. (2017). An exploration of the mechanisms of change following an integrated group intervention for stuttering, as perceived by school-aged children who stutter (CWS). Journal of Fluency Disorders, 51, 8–23.

    Article  PubMed  Google Scholar 

  • Crits-Christoph, P., Gibbons, M. B. C., & Mukherjee, D. (2013). Psychotherapy process outcome research. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.). (pp. 298–339). New York: Wiley.

    Google Scholar 

  • De Los Reyes, A., Aldao, A., & Augenstein, T. M. (2017). Assessment issues in child and adolescent psychotherapy. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (3rd ed.). (pp. 537–554). New York: Guilford Press.

    Google Scholar 

  • Dew, S. E., & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7(1), 21–33.

    Article  PubMed  Google Scholar 

  • Dolbier, C. L., & Steinhardt, M. A. (2000). The development and validation of the sense of support scale. Behavioral Medicine, 25, 169–179.

    Article  PubMed  Google Scholar 

  • Eddy, J. M., & Chamberlain, P. (2000). Family management and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior. Journal of Consulting and Clinical Psychology, 68, 857–863.

    Article  PubMed  Google Scholar 

  • Forgatch, M. S., & DeGarmo, D. S. (1999). Parenting through change: an effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67(5), 711–724.

    Article  PubMed  Google Scholar 

  • Foster, S. L., & Robin, A. L. (1997). Family conflict and communication in adolescence. In E. J. Mash & L. G. Terdal (Eds.), Assessment of childhood disorders (3rd ed.). (pp. 627–682). New York: Guilford.

    Google Scholar 

  • Frisch, M. B. (2014). Quality-of-life-inventory. In R. A. Cummins & A. C. Michalos (Eds.), Encyclopedia of quality of life and well-being research. (pp. 5374–5377). Netherlands: Springer

  • Frisch, M. B., Clark, M. P., Rouse, S. V., Rudd, M. D., Paweleck, J. K., Greenstone, A., & Kopplin, D. A. (2005). Predictive and treatment validity of life satisfaction and the quality of life inventory. Assessment 12(1), 66–78.

    Article  PubMed  Google Scholar 

  • Henderson, C. E., Rowe, C. L., Dakof, G. A., Hawes, S. W., & Liddle, H. A. (2009). Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy. American Journal of Drug and Alcohol Abuse, 35(4), 220–226.

    Article  PubMed  PubMed Central  Google Scholar 

  • Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 37–69). New York: Oxford University Press.

    Google Scholar 

  • Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16.

    Article  PubMed  Google Scholar 

  • Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the working alliance inventory. Journal of Counseling Psychology, 36, 223–233.

    Article  Google Scholar 

  • Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2005). A theoretical model of common process factors in youth and family therapy. Mental Health Services Research, 7, 35–52.

    Article  PubMed  Google Scholar 

  • Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26, 50–65.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (2000). Perceived barriers to treatment participation and treatment acceptability among antisocial children and their families. Journal of Child and Family Studies, 9, 157–174.

    Article  Google Scholar 

  • Kazdin, A. E. (2009). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. New York: Oxford University Press.

    Google Scholar 

  • Kazdin, A. E. (2014). Moderators, mediators, and mechanisms of change in psychotherapy. In W. Lutz & S. Knox (Eds.), Quantitative and qualitative methods in psychotherapy (pp. 87–101). East Sussex: Routledge.

    Google Scholar 

  • Kazdin, A. E. (2015). Psychosocial treatments for conduct disorder in children a nd adolescents. In P. E. Nathan, J. M. Gorman (eds.) A guide to treatments that work (4th ed.). (pp. 141–173). New York: Oxford University Press. .

  • Kazdin, A. E. (2017a). Parent management training and problem-solving skills training for child and adolescent conduct problems. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents. (3rd ed.). (pp. 142–158). New York: Guilford Press.

    Google Scholar 

  • Kazdin, A. E. (2017b). Research design in clinical psychology (5th ed.). Boston, MA: Pearson.

    Google Scholar 

  • Kazdin, A. E., Bass, D., Ayers, W. A., & Rodgers, A. (1990). The empirical and clinical focus of child and adolescent psychotherapy research. Journal of Consulting and Clinical Psychology, 58, 729–740.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Durbin, K. A. (2012). Predictors of child-therapist alliance in cognitive-behavioral treatment of children referred for oppositional and antisocial behavior. Psychotherapy, 49, 202–217.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Holland, L., & Crowley, M. (1997a). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65, 453–463.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997b). Barriers to participation in treatment scale: evaluation and validation in the context of child outpatient treatment. Journal of Child Psychology and Psychiatry, 38, 1051–1062.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Marciano, P. L., & Whitley, M. (2005). The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior. Journal of Consulting and Clinical Psychology, 73, 726–730.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Siegel, T., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60, 733–747.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Wassell, G. (2000). Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health Services Research, 2, 27–40.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Whitley, M. K. (2006). Pretreatment social relations, therapeutic alliance, and improvements in parenting practices in parent management training. Journal of Consulting and Clinical Psychology, 74, 346–355.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Whitley, M., & Marciano, P. L. (2006). Child-therapist and parent-therapist alliance and therapeutic change in the treatment of children referred for oppositional, aggressive, and antisocial behavior. Journal of Child Psychology and Psychiatry, 47, 436–445.

    Article  PubMed  Google Scholar 

  • Kurdek, L. A. (1992). Dimensionality of the dyadic adjustment scale: evidence from heterosexual and homosexual couples. Journal of Family Psychology, 6(1), 22–35.

    Article  Google Scholar 

  • Lloyd, B. H., & Abidin, R. R. (1985). Revision of the parenting stress index. Journal of Pediatric Psychology, 10, 169–177.

    Article  Google Scholar 

  • Mischel, W., & Shoda, Y. (1995). A cognitive-affective system theory of personality: Reconceptualizing situations, dispositions, dynamics, and invariance in personality structure. Psychological Review, 102, 246–268.

    Article  PubMed  Google Scholar 

  • Moos, R. H., & Moos, B. S. (1981). Family Environment Scale manual. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Norcross, J. C. (Ed.) (2011). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York: Oxford University Press.

    Google Scholar 

  • Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed.). (pp. 307–389). New York: Wiley.

    Google Scholar 

  • Rabbitt, S. M., Carrubba, E., Lecza, B., McWhinney, E., Pope, J., & Kazdin, A. E. (2016). Reducing therapist contact in parenting programs: evaluation of internet-based treatments for child conduct problems. Journal of Child and Family Studies, 25(6), 2001–2020.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shirk, S. R., & Karver, M. S. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 452–464.

    Article  PubMed  Google Scholar 

  • Shirk, S. R., Karver, M. S., & Brown, R. (2011). The alliance in child and adolescent psychotherapy. Psychotherapy, 48, 17–24.

    Article  PubMed  Google Scholar 

  • Spanier, G. B., & Thompson, L. (1982). A confirmatory analysis of the dyadic adjustment scale. Journal of Marriage and the Family, 44, 731–738.

    Article  Google Scholar 

  • Zilcha-Mano, S. (2017). Is the alliance really therapeutic? Revisiting this question in light of recent methodological advances. American Psychologist, 72(4), 311–325.

    Article  PubMed  Google Scholar 

  • Zilcha-Mano, S., & Errázuriz, P. (2017). Early development of mechanisms of change as a predictor of subsequent change and treatment outcome: the case of working alliance. Journal of Consulting and Clinical Psychology, 85(5), 508–520.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported in part by MH59029 from the National Institute of Mental Health and by Yale University.

Author information

Authors and Affiliations

  1. Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT, 06520, USA

    Alan E. Kazdin & Emily McWhinney

Authors
  1. Alan E. Kazdin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily McWhinney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alan E. Kazdin.

Ethics declarations

Conflict of Interest

Alan Kazdin has received a research grant from NIMH for this work. The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kazdin, A.E., McWhinney, E. Therapeutic Alliance, Perceived Treatment Barriers, and Therapeutic Change in the Treatment of Children with Conduct Problems. J Child Fam Stud 27, 240–252 (2018). https://doi.org/10.1007/s10826-017-0869-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-017-0869-3

Keywords

Search

Navigation