Therapeutic alliance is a robust predictor of future therapeutic outcomes. While treatment of normal children and adolescents is often hard, treating antisocial youth is especially difficult because of the social, cognitive, and emotional deficits experienced by these youth. This study investigated whether differing levels of callous-unemotional (CU) traits influenced the formation of therapeutic alliance in a sample of 51 adjudicated youth in juvenile institutions. Also, we tested whether therapeutic alliance influenced success in the institution and whether this association differed based on levels of CU traits. Results revealed that CU traits and selfreported delinquency were both modestly related to institutional infractions. Children low on both dimensions showed the lowest levels of institutional infractions. Additionally, these findings suggest that children high on both CU traits and delinquency reported better therapeutic alliance, but that youth with high CU traits committed more institutional infractions, despite their level of therapeutic alliance.

Background: Interventions for young children with autism are increasingly delivered through parents. This thesis investigated baseline and process variables associating with quality of parent-therapist alliance in a parent-mediated intervention for autism, including variables relating to parents' causal beliefs and perspectives. Participants: 77 parents and 6 therapists from a RCT of a parent-mediated intervention for autism (PACT). Method: A sequential exploratory mixed methods approach, with an intermediary instrument development phase. Baseline variables, investigated for the full sample of 77 cases, comprised demographic variables, parental dichotomous causal belief variables, and a therapist average fidelity variable. Thematic analysis of intervention session transcripts informed the development of the Parental Perspectives Coding Scheme (PPCS), a video-based scheme for rating the quality of parent 'Expression' and therapist 'Integration' of parental perspectives during intervention. 5 overarching themes were initially identified, these were collapsed into three items for the PPCS; Interpretation of the Child (IOC), Parent Actions and Strategies (PAS) and Parental Self Disclosures (PSD). Item inter-rater reliabilities were satisfactory to good. Parent-therapist dialogue, for a sub-sample of 20 cases, was coded using the PPCS to create process variables for the Expression and Integration of parental perspectives. Initial analyses identified baseline and process variables with significant univariate associations with alliance; these were included in separate multivariate models of parent-rated alliance and therapist-rated alliance. Results: Parent-rated and therapist-rated alliance did not correlate. PPCS Expression and Integration scores were higher in the high parent-rated alliance group but the difference was non-significant. Parents who cited MMR as a possible cause of their child's autism rated the alliance significantly lower than those who did not. Parents with no post-16 qualifications rated the alliance significantly higher than those with higher qualifications. Each factor contributed independently to a multiple regression model, together explaining 18.3% of variance in parent-rated alliance. Therapist-rated alliance significantly correlated positively with therapist fidelity and with PPCS variables for parent Expression and therapist Integration; together these explained 58.8% of variance in therapist-rated alliance. Conclusions: Therapists should be aware that parents may rate the alliance differently from themselves and that different factors associate with their ratings. Parents' causal beliefs and level of education may influence their ratings of alliance in specific interventions.

The Clinical Support Tools (CST) was developed to help therapists organize and target potential problems that might account for negative outcomes in psychotherapy. The core of CST feedback is The Assessment for Signal Clients (ASC). The purpose of this study was to describe and identify patterns of problems that typically characterize off-track cases. A cluster analysis of 107 off-track clients revealed three client types: those whose problems were characterized by alliance and motivational difficulties; those characterized by social support and life event difficulties; and those whose problems had an indistinguishable pattern. Loglinear modeling showed that if patients had less therapeutic alliance problems they were also less likely to have motivational problems. Findings were also consistent with the cluster analysis, which showed that a relatively higher percentage of not-on-track participants received signal alerts for the social support items and scale. Individuals whose progress goes off-track appear to have their greatest difficulty with social support, losses, and therapy task agreement.

Abstract Substance misuse is a global phenomenon. However, little is known about substance misuse issues in Islamic nations or about the provision of preventative and rehabilitative services in such nations. This thesis explores the legal context of such services in the Maldives and pays particular attention to tensions between the formal policies of the National Narcotics Control Bureau and clinical practice. Findings are drawn from a review of government and service policy documents, five semi-structured individual interviews with clinical practitioners and senior administrative staff from rehabilitative services, and a three day focus group workshop with clinical staff. Findings show the lack of awareness of the legal and policy contexts for service provision and the ways in which existing policy frameworks often detract from the forging of therapeutic alliances. The primary concern raised by the analysis is the lack of involvement of clinical staff in policy formation and revision. This contributes to series of tensions and contradictions between official aims for services and the actual provision of these services. Further a range of ethical issues arose as a result of inadequate professional monitoring, training, and peer review. Recommendations are made regarding how these issues should be addressed in order to enhance the Maldivian response to increasing substance misuse.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves [114]-129). Also available on the Internet.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2010. / Typescript. Includes bibliographical references (p. 19-21).

Participants on sex offender treatment programmes (SOTPs) seem to value victim empathy (VE) training exercises, despite there being little evidence to suggest that these reduce risk of reoffending. Participants also appear to value their therapeutic relationships. There has been very little research into SOTP facilitators’ views on treatment. This study explores whether facilitators also feel VE training is a useful part of treatment and if seeing empathy develop in offenders strengthens therapeutic alliance. 12 prison SOTP facilitators were interviewed. The transcripts were analysed using content and thematic analysis, there were six main findings. Facilitators were concerned that the perceived impact of VE was superficial compliance and the particular emotional aspect of VE training may help facilitators to empathise with difficult group members. This study contributes a facilitator perspective to the debate on including VE training in SOTPs, and suggests further research be completed into empathy constructs and how these apply to facilitators work.

No description available.

Dyadic data analysis methods are underutilized in child and youth care, where much of the practice relies on relationships with individuals and groups. In this exploratory study, a dyadic data analysis approach was used to study the interdependence amongst client-counsellor dyads in a voluntary counselling setting. Ten counsellors and thirty-six clients from a Canadian voluntary counselling agency participated in this study. Counselling sessions ranged from two to 20 sessions. Clients completed a session rating scale, a measure of the therapeutic alliance. In addition, clients and counsellors completed an outcome rating scale and personal change questions. A one-with-many design was used to explore the similarity between client-counsellor dyads, the degree of consensus, assimilation, and uniqueness as well as the level of reciprocity for perceived client well-being. Multi-level modeling was used to partition the variance on the outcome rating scale to account for sources of non-independence in client-counsellor dyads, and the indirect relationships between multiple clients working with the same counsellor. Implications of the study and recommendations for future research are discussed. / Graduate

Group psychotherapy is the most widely utilized treatment modality for convicted sex offenders, and the therapeutic alliance is considered a fundamental concept in virtually all applications of psychotherapy. However, empirical examination of how the therapeutic alliance impacts upon treatment effectiveness for sex offenders has been neglected. In a prospective design, a sample of 95 consecutive admissions to an inpatient treatment program for convicted adult male sex offenders was studied with regard to their experience of the therapeutic alliance with treatment staff, with their copatients, and with the overall treatment program. Patients of the Phoenix Program (Alberta Hospital Edmonton) rated their sense of alliance at monthly intervals. The therapists who worked with them (n = 21) also completed monthly evaluations of their own emotional responses toward these same patients. Pre- to post-treatment comparisons on personality tests, interpersonal distress, and interpersonal functioning showed a number of statistically significant changes consistent with treatment goals. Patients self-report over time in treatment showed a gradual, consistent increase of large effect size on all three alliance targets. Sex offenders in this sample were able to experience positive alliance with therapists and peers and the sense of alliance was shown to grow stronger over time. Staff ratings revealed that positive and negative affect increased as patients time in treatment increased. Significant associations between patient-rated alliance and outcome were found to be positive and in desired directions. The growth rate in alliance toward therapists was positively and significantly associated with the growth rate of conflict within oneself among female therapists. Male therapists also reported significant growth in conflict within oneself but this was independent of patient-rated alliance growth rates. Thus, female therapists experienced heightened affect in the face of greater patient alliance, while male therapists also experienced heightened affect but for reasons unrelated to patient alliance. There was virtually no reduction in negative affect toward patients despite moderate increases in positive affect toward patients. This study represents an important endorsement of a treatment model that seeks to improve general adjustment and ameliorate risk factors associated with recidivism, via positive changes in interpersonal relationships. / Psychiatry