ABSTRACT

Background: Caregivers play a key role in the success of trauma-focused cognitive behavioural therapy (TF-CBT). Yet, the effect of their alliance on treatment outcomes besides the other parties in treatment has hardly been studied.

Objective: This study examined the working alliance (WA) of therapists, patients and caregivers in TF-CBT and its contribution on treatment outcome over time.

Methods: N = 76 children and adolescents (mean age = 12.66 years, range 7–17, M/F ratio: .43) participated in the TF-CBT arm of a randomized controlled trial. The WA was assessed with the Working Alliance Inventory Short Version (WAI-S) at two measurement points, while symptom level of posttraumatic stress symptoms (PTSS) was assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Paired sample t-tests, intraclass correlations (ICC), and mixed-effects regression models for longitudinal data were performed.

Results: The alliance rating was high across all informants, with caregivers achieving the highest rating. The average level of cross-informant agreement on the alliance was low between therapists and caregivers (ICC = .26) and moderate between therapists and patients (ICC =.65). A significant contribution of an alliance improvement to the reduction of PTSS over time was found in each of the two tested models: therapists with patients model (b = .682) and therapists with caregivers model (b = .807). However, these effects were not detected with all four perspectives in one comprehensive model.

Conclusion: In summary, the potential of caregivers’ views should receive more attention in the therapeutic process of trauma-focused therapy.

摘要

背景：护理人员在以创伤为重点的认知行为疗法（TF-CBT）的成功中起着关键作用。然而，几乎没有研究他们的联盟对治疗其他各方的影响。

目的：本研究探讨了TF-CBT中治疗师，患者和护理人员的工作联盟（WA）及其对治疗结果的长期影响。

方法：N名76名儿童和青少年（平均年龄= 12.66岁，范围7–17，男女比例：.43）参加了一项随机对照试验的TF-CBT组。用两个工作点的工作联盟清单简短版（WAI-S）评估西澳大利亚州，而创伤后应激症状（PTSS）的症状水平则由临床医师管理的儿童和青少年PTSD量表（CAPS-CA）进行评估。对纵向数据进行配对样本t检验，组内相关性（ICC）和混合效应回归模型。

结果：联盟得分在所有被举报人中都很高，看护者的得分最高。治疗师和护理人员之间就联盟达成的交叉信息协议的平均水平较低（ICC = 0.26），而治疗师与患者之间的中等水平（ICC = 0.65）。在两个测试模型中的每一个中都发现了联盟改善对降低PTSS的重大贡献：患者模型的治疗师（b = .682）和护理者模型的治疗师（b = .807）。但是，在一个综合模型中，无法从所有四个角度检测到这些影响。

结论：总而言之，在以创伤为中心的治疗过程中，应更多地关注看护者的观点。