OBJECTIVE Trauma-focused cognitive-behavioral therapy (TF-CBT) is a recommended treatment for posttraumatic stress (PTS) in youth, and a strong therapeutic alliance predicts reductions of PTS in TF-CBT. However, little is known of how therapists can build a strong alliance. This study seeks to understand which therapist behaviors are associated with the strength of alliance in TF-CBT. METHOD Participants were 65 youth (M age = 15.1, SD = 2.19; 77% girls) engaged in TF-CBT and their therapists (n = 24). The alliance was assessed midtreatment using the Therapeutic Alliance Scale for Children-revised. Therapists' behaviors were coded using the Adolescent Alliance-Building Scale-revised, and youth engagement behavior was coded using the Behavioral Index of Disengagement Scale. Linear mixed-effects models were used to evaluate clients' and therapists' in-session behaviors as predictors of the alliance, in addition to assessing the potential moderating effects of youth behaviors. RESULTS Rapport-building behaviors were significantly predictive of higher alliance scores (Est. = 1.81, 95% CI [0.11, 3.52], p = .038), whereas there was no predictive effect of treatment socialization or trauma-focusing behavior on alliance scores. Initial youth behavior significantly moderated the effect of trauma-focusing on the alliance (p = .007); greater focus on trauma was associated with higher alliance scores among passively disengaged youth (Est. = 4.92, 95% CI [1.80, 8.05], p = .003). CONCLUSIONS Rapport-building behaviors are associated with a stronger alliance in TF-CBT. Gradual exposure through initial trauma-eliciting does not appear to undermine alliance formation but is rather associated with higher alliance-scores among passively disengaged youth. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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在以创伤为重点的认知行为疗法中，治疗师的行为与青少年的治疗联盟。

目的以创伤为重点的认知行为疗法（TF-CBT）是青少年创伤后应激（PTS）的推荐治疗方法，强有力的治疗联盟预测TF-CBT的PTS降低。但是，对于治疗师如何建立牢固的联盟知之甚少。本研究旨在了解哪些治疗师的行为与TF-CBT中联盟的力量有关。方法参加研究的是65名青年（M年龄= 15.1，SD = 2.19； 77％的女孩）从事TF-CBT及其治疗师（n = 24）。使用修订的儿童治疗联盟量表对联盟进行了中期治疗评估。治疗师的行为采用修订后的《青少年联盟建筑量表》进行编码，青少年参与行为采用《脱离接触行为量表》进行编码。线性混合效应模型用于评估客户的 除评估青年行为的潜在调节作用外，还包括治疗师的会期行为作为该联盟的预测指标。结果建立关系的行为显着预测了较高的联盟得分（Est。= 1.81，95％CI [0.11，3.52]，p = .038），而治疗社交化或针对创伤的行为对联盟得分没有预测作用。青年时期的最初行为显着减轻了创伤对联盟的影响（p = .007）；在被动脱离的青年中，对创伤的更多关注与更高的联盟得分相关（Est。= 4.92，95％CI [1.80，8.05]，p = .003）。结论建立关系的行为与TF-CBT中更强大的联盟有关。通过最初引起创伤的逐渐暴露似乎并未破坏联盟的形成，但与被动脱离的青年中更高的联盟得分相关。（PsycINFO数据库记录（c）2020 APA，保留所有权利）。