Associations between Therapeutic Alliance and Treatment Outcomes in an Intervention for Children with Externalizing Behavior and Mild to Borderline Intellectual Disabilities

Abstract

The quality of the alliance between client and therapist is suggested to be a critical factor in explaining treatment outcomes in both adult and child psychotherapy. This study examines associations between the therapeutic alliance (TA) and the effectiveness of Standing Strong Together (SST), a group-based parent and child intervention for children with mild to borderline intellectual disabilities (MBID; IQ 55-85) and externalizing behavior. A repeated measures design is used to assess externalizing behavior, positive parenting and the parent-child relationship before and after treatment (N = 97). Audio-recordings of mid-treatment sessions were analyzed to examine the TA quality. In the current study, children in families with a high TA quality showed greater reductions in externalizing behavior, reported by their parents, than did children in families with a low TA quality. The child-therapist alliance individually predicted externalizing behavior reductions, while the parent-therapist alliance did not. Therapeutic alliance quality was not associated with SST outcomes in terms of positive parenting and the parent-child relationship. Findings of the current study demonstrate that a high quality of therapeutic alliance in Standing Strong Together is associated with a stronger decrease of externalizing behavior in children with MBID.