Navigating two alliances with evidence-based practices : relating therapist competence and adherence to youth and caregiver therapeutic alliances

Despite extensive research on specific treatments and relationship factors in child and adolescent psychotherapy, comparatively little research has addressed in-session process variables concerning how a treatment is delivered. This study examines treatment integrity (therapist adherence and competence) in the delivery of evidence-based practice (EBP) elements and the two therapeutic alliances in youth psychotherapy: the youth-therapist alliance and the caregiver-therapist alliance. Data come from an initial test of a modular, trans-diagnostic therapy protocol of EBP elements with 14 therapists seeing 24 clients and were analyzed using Hierarchical Linear Modeling (HLM). Therapist adherence, competence, and alliance were all measured observationally. In this sample, therapist adherence contributed a small, statistically trending effect on child alliance (d [subscript wt] = 0.008, p = 0.055), while therapist competence did not predict child alliance. Therapist adherence exhibited a small, statistically significant effect on parent alliance (d [subscript wt] = 0.007, p = 0.023). Therapist competence exhibited a large, statistically trending effect on parent alliance (d [subscript wt] = 0.675, p = 0.059). Results suggest that EBP does not harm the therapeutic alliance and may support a stronger alliance with caregivers. Future research should use larger samples to explore how these constructs interact with therapist, youth, and caregiver characteristics to produce outcomes.