European Journal of Psychotraumatology ( IF 4.2 ) Pub Date : 2020-05-13 S. Loos, D. Tutus, R. Kilian, L. Goldbeck
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.
中文翻译:
照顾者的观点重要吗?儿童和青少年针对创伤的认知行为治疗中的工作联盟和治疗结果
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。