What builds the bond?

Abstract

The study is the first to examine the effects of children's and therapists' in-session behaviors on later therapeutic alliance (TA; i.e., relational bond, task collaboration) as rated by children and therapists in an intervention for children with aggressive behavior. One hundred eighty children (ages 9.3-11.8; 69% male; 78% Black), screened as having aggressive behavior by teacher and parent ratings, received a 32-session group-based cognitive-behavioral intervention (Coping Power) at their schools. TA ratings were collected from children and therapists at mid- and end-of-intervention using the Therapeutic Alliance Scale for Children. Children's and therapists' behaviors during the first 16 sessions were coded by independent observers. Children's negative in-session behaviors predicted lower child- and therapist-rated TA (averaged across mid- and end-of-intervention). Children's in-session positive behaviors, at both the individual and group-wide level, predicted higher later TA. Therapists' efforts to manage deviant behavior predicted stronger child-reported ratings of the relational bond and of child- and therapist-rated task collaboration. Exploratory analyses indicate that the effect of children's in-session behaviors on later TA is moderated by therapists' skills in managing the group and in managing deviant talk and behavior in sessions. Clinical and research implications of the findings are discussed.