The relationship between youth involvement, alliance and outcome in trauma-focused cognitive behavioral therapy.

Objective: Research suggests that combining the trauma-specific elements with a strong alliance helps optimize treatment outcomes in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth. Building on this, we investigate whether more positive and less negative involvement behaviors during trauma narration are associated with a stronger alliance and predict fewer posttraumatic stress symptoms (PTSS).

Method: Participants were 65 youth ( age = 15.5,  = 2.2; 77% girls) receiving TF-CBT. Both youth self-report (Child PTSD Symptom Scale and Therapeutic Alliance Scale for Children) and observer ratings (Client Involvement Rating Scale) were used, and relationships were investigated with correlations and regression analyses.

Results: The positive involvement behaviors and predicted fewer PTSS but were not associated with the alliance - while predicted more PTSS but were associated with a stronger alliance. The negative involvement behaviors and did not predict PTSS but were negatively associated with the alliance.

Conclusion: The relationships between traumatized youths' positive and negative involvement behaviors, alliance and PTSS outcomes appear mixed. The combination of a clear understanding of why processing the trauma can be helpful, more trauma-related self-disclosure and a stronger alliance seem favorable for alleviating PTSS. ClinicalTrials.gov identifier: NCT00635752..