The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists

Submitted: June 19, 2021
Accepted: February 24, 2022
Published: March 4, 2022
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Through the perspectives of children, parents and therapists, this study explored the therapeutic relationship as a change facilitator in different moments of psychotherapy. The children, parents, and therapists (N=15) who formed part of five therapeutic treatments were studied using a qualitative, longitudinal design. Thirty semi-structured interviews were done; half at the beginning and half after four months of psychotherapy. Children’s drawings were incorporated, and data were analysed through grounded theory methods and qualitative analysis guidelines for drawings. Participants identified several aspects of the therapeutic relationship as change facilitators. From the first encounters, the therapists’ close and adaptable attitude promoted an improved motivation for psychotherapy and enhanced engagement among children and parents. Later in the process, a positive, child-centred and affective therapeutic relationship fostered the child’s trust with the therapist as well as a positive relational experience, promoting associated changes in children and the development of socio-affective tools. Parents and therapists saw their own relationship as a change facilitator, as well as a broader understanding in parents of their children and an improved relationship with them. Parent’s and child’s changes helped each other. Specific and common aspects between participants’ perspectives provided a richer understanding of the studied phenomena. This study supports the view that a positive therapeutic relationship facilitates early changes in the motivation of children and parents, and provides them with a healing, relational experience as it develops. A positive parent-therapist relationship is also key for changes to further progress.

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Abrishami, G. F., & Warren, J. S. (2013). Therapeutic alliance and outcomes in children and adolescents served in a community mental health system. Journal of Child and Adolescent Behavior, 1(2), 1-7. doi:10.4172/2375-4494.1000110. DOI: https://doi.org/10.4172/2375-4494.1000110
Accurso, E., & Garland, A. (2015). Child, caregiver, and therapist perspectives on therapeutic alliance in usual care child psychotherapy. Psychological Assessment, 27(1), 347-352. doi:10.1037/pas0000031. DOI: https://doi.org/10.1037/pas0000031
Alamo, N. (2019). Contenidos y evolución del cambio en la psicoterapia con niños y niñas: Propuesta de un modelo genérico y de proceso [Contents and evolution of change in psychotherapy with boys and girls: Proposal for a generic and process model] [Doctoral dissertation, Pontifical Catholic University of Chile]. Pontifical Catholic University of Chile Repository. Available from: https://repositorio.uc.cl/handle/11534/22501
Altimir, C., Capella, C., Núñez, L., Abarzúa, M., & Krause, M. (2017). Meeting in difference: Revisiting the therapeutic relationship based on patients' and therapists' experiences in several clinical contexts. Journal of Clininical Psychology, 73, 1510-1522. doi:10.1002/jclp.22525. DOI: https://doi.org/10.1002/jclp.22525
Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65, 755-768. doi:10.1002/jclp.20583. DOI: https://doi.org/10.1002/jclp.20583
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, 16, 252-260. doi:10.1037/h0085885. DOI: https://doi.org/10.1037/h0085885
Campbell, A. F., & Simmonds, J. G. (2011). Therapist perspectives on the therapeutic alliance with children and adolescents. Counselling Psychology Quarterly, 24(3), 195-209. doi:10.1080/09515070.2011.620734. DOI: https://doi.org/10.1080/09515070.2011.620734
Capella, C., Gutiérrez, C., Rodríguez, L. & Gómez, C. (2018). Change during psychotherapy: the perspective of children and adolescents who have been sexually abused. Research in Psychotherapy: Psychopathology, Process and Outcome, 21(1), 24-39. doi:10.4081/ripppo.2018.288. DOI: https://doi.org/10.4081/ripppo.2018.288
Capella, C., Lama, X., Rodríguez, L., Águila, D., Beiza, G., Dussert, D. & Gutiérrez, C. (2016). Winning a Race: Narratives of Healing and Psychotherapy in Children and Adolescents Who Have Been Sexually Abused. Journal of Child Sexual Abuse, 25(1), 73-92. doi:10.1080/10538712.2015.1088915. DOI: https://doi.org/10.1080/10538712.2015.1088915
Capella, C., Rodriguez, L., Aguila, D., Dussert, D., Lama, X., Gutierrez, C. & Beiza, G. (2015). Storied images of psychotherapeutic change: Approaching children ́s voices through drawings. Research in Psychotherapy: Psychopathology, Process and Outcome, 18(2), 141-151. doi:10.4081/ripppo.2015.188. DOI: https://doi.org/10.4081/ripppo.2015.188
Carlberg, G., Thoren, A., Billstrom, S., & Odhammar, F. (2009). Children’s expectations and experiences of psychodynamic child psychotherapy. Journal of Child Psychotherapy, 35 (2), 175-193. doi:10.1080/00754170902996130. DOI: https://doi.org/10.1080/00754170902996130
Carroll, J. (2002). Play therapy: the children’s views. Child and Family Social Work, 7(3), 177-187. doi:10.1046/j.1365-2206.2002.00234.x. DOI: https://doi.org/10.1046/j.1365-2206.2002.00234.x
Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). doi:10.4135/9781452230153. DOI: https://doi.org/10.4135/9781452230153
Elliott, R. (2008). Research on client experiences of therapy: Introduction to the special section. Psychotherapy Research 18(3), 239-242. doi:10.1080/10503300802074513. DOI: https://doi.org/10.1080/10503300802074513
Erekson, D., Janis, R., Bailey, R., Cattani, K., & Pedersen, T. (2017). A Longitudinal Investigation of the Impact of Psychotherapist Training: Does Training Improve Client Outcomes? Journal of Counseling Psychology, 64(5), 514-524. doi:10.1037/cou0000252. DOI: https://doi.org/10.1037/cou0000252
Fernández, O., Pérez, C., & Krause, M. (2016). Therapeutic alliance in the initial phase of psychotherapy with adolescents: different perspectives and their association with therapeutic outcomes. Research in Psychotherapy: Psychopathology, Process and Outcome, 19(1), 1-9. doi:10.4081/ripppo.2016.180. DOI: https://doi.org/10.4081/ripppo.2016.180
Flick, U. (2018). An introduction to qualitative research (6th ed.). Los Angeles: SAGE publications Ltd.
Fonagy, P., Cottrell, D., Phillips, J., Bevington, D., Glaser, D., & Allison, E. (2015). What Works for Whom? A Critical Review of Treatments for Children and Adolescents (2nd ed.). London: The Guildford Press.
Gelso, C. (2019). The Therapeutic Relationship in Psychotherapy Practice. An Integrative Perspective. New York: Routledge. DOI: https://doi.org/10.4324/9781315658063
Gelso, C. (2014). A tripartite model of the therapeutic relationship: Theory, research, and practice. J. Psychotherapy Research, 24, 117-131. doi:10.1080/10503307.2013.845920. DOI: https://doi.org/10.1080/10503307.2013.845920
Gelso, C. J., & Kline, K. V. (2019). The sister concepts of the working alliance and the real relationship: on their development, rupture, and repair. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(2), 142-149. doi:10.4081/ripppo.2019.373. DOI: https://doi.org/10.4081/ripppo.2019.373
Gómez, J.M. & Roussos, A. (2012). Series on upgrading methodology in clinical psychology. How do we know if our patients are improving? Criteria for clinical significance in psychotherapy: a renewed debate. Revista Argentina de Clínica Psicológica, 21(2), 173-190.
Gonçalves, M., Matos, M. & Santos, A. (2009). Narrative therapy and the nature of ‘innovative moments’ in the construction of change. Journal of Constructivist Psychology, 22(1), 1-23. doi:10.1080/10720530802500748. DOI: https://doi.org/10.1080/10720530802500748
Green, J. (2006). Annotation: The therapeutic alliance - a significant but neglected variable in child mental health treatment studies. Journal of Child Psychology and Psychiatry, 47(5), 425-435. doi:10.1111/j.1469-7610.2005.01516.x. DOI: https://doi.org/10.1111/j.1469-7610.2005.01516.x
Gvion, Y., & Bar, N. (2014). Sliding doors: some reflections on the parent-child-therapist triangle in parent work-child psychotherapy. Journal of Child Psychotherapy, 40(1), 58-72. doi:10.1080/0075417X.2014.883138. DOI: https://doi.org/10.1080/0075417X.2014.883138
Hawley, K. M., & Weisz, J. R. (2005). Youth versus parent working alliance in usual clinical care: Distinctive associations with retention, satisfaction, and treatment outcome. Journal of Clinical Child and Adolescent Psychology, 34(1), 117-128. doi:10.1207/s15374424jccp3401_11. DOI: https://doi.org/10.1207/s15374424jccp3401_11
Horvath, A. O. (2006). The alliance in context: Accomplishments, challenges, and future directions. Psychotherapy: Theory, Research, Practice, Training, 43(3), 258-263. doi:10.1037/0033-3204.43.3.258. DOI: https://doi.org/10.1037/0033-3204.43.3.258
Horvath, A., Del Re, A. C., Flükiger, C., & Symonds, D. (2011). Alliance in Individual Therapy. In Norcross, J. (Ed.), Therapeutic relationships that work: Evidence-Based Responsiveness (pp. 25-69). New York: Oxford University Press. DOI: https://doi.org/10.1093/acprof:oso/9780199737208.003.0002
Karush, R. (2014). Postscripts: Reflections on the post-termination phase. The Psychoanalytic Study of the Child, 68, 234-247. doi:10.1080/00797308.2015.11785516. DOI: https://doi.org/10.1080/00797308.2015.11785516
Karver, M. S., Monahan, M., De Nadai, A. S., & Shirk, S. R. (2018). Meta-Analysis of the Prospective Relation Between Alliance and Outcome in Child and Adolescent Psychotherapy. Psychotherapy, 55(4), 341-355. doi:10.1037/pst0000176. DOI: https://doi.org/10.1037/pst0000176
Kazdin A. E., & Durbin, K. A. (2012). Predictors of child-therapist alliance in cognitive- behavioral treatment of children referred for oppositional and antisocial behavior. Psychotherapy (Chic., III) 49(2), 202-217. doi:10.1037/a0027933. DOI: https://doi.org/10.1037/a0027933
Kazdin, A. E., Whitley, M., & Marciano, P. L. (2006). Child-therapist and parent-therapist alliance and therapeutic change in a treatment referred for oppositional, aggressive, and antisocial behaviour. Journal of Child Psychology and Psychiatry, 47(5), 436-445. doi:10.1111/j.1469-7610.2005.01475.x. DOI: https://doi.org/10.1111/j.1469-7610.2005.01475.x
Krause, M., de la Parra, G., Arístegui, R., Dagnino, P., Tomicic, A., Valdés, N., Vilches, O., Echávarri, O., Ben Dov, P., Reyes, L., Altimir, C., & Ramírez, I. (2006). Indicadores genéricos de cambio en el proceso psicoterapéutico. Revista Latinoamericana de Psicología, 38(2), 299-325.
Krause, M. (2005). Psicoterapia y cambio. Una mirada desde la subjetividad [Psychotherapy and change. A view from subjectivity]. Santiago de Chile: Ediciones Universidad Católica.
Levitt, H. (2021). Essentials of Critical-Constructivist Grounded Theory Research. Washington, DC: American Psychological Association. DOI: https://doi.org/10.1037/0000231-000
Liber, J., McLeod, B., Van Widenfelt, B., Goedhart, A., Van der Leeden, A., Utens, E., & Treffers, P. (2010). Examining the relation between the therapeutic alliance, treatment adherence, and outcome of cognitive behavioral therapy for children with anxiety disorders. Behavior Therapy, 41(2), 172-186. doi:10.1016/j.beth.2009.02.003. DOI: https://doi.org/10.1016/j.beth.2009.02.003
Marker, C., Comer, J., Abramova, V., & Kendall, P. (2013). The reciprocal relationship between alliance and symptom improvement across treatment of childhood anxiety. Journal of Clinical Child & Adolescent Psychology, 42(1), 22-33. doi:10.1080/15374416.2012.723261. DOI: https://doi.org/10.1080/15374416.2012.723261
Mergenthaler, E., & Gril, S. (1996). Descripción de las reglas para la transcripción de sesiones de psicoterapia [Description of the rules for the transcription of psychotherapy sessions]. Revista Argentina de Clínica Psicológica 5(2), 163-176.
Midgley, N. (2004). Sailing between Scylla and Charybdis: Incorporating qualitative approaches into child psychotherapy research. Journal of Child Psychotherapy, 30(1), 89-111. doi:10.1080/0075417042000205814. DOI: https://doi.org/10.1080/0075417042000205814
Midgley, N., Hayes, J., & Cooper, M. (2017). Essential research findings in child and adolescent counselling and psychotherapy. London: SAGE publications Ltd.
Midgley, N. & Navridi, E. (2006) An exploratory study of premature termination in child analysis. Journal of Infant, Child and Adolescent Psychotherapy, 5(4), 437-58. doi:10.1080/15289160701382360. DOI: https://doi.org/10.1080/15289160701382360
Noyce, R., & Simpson, J. (2018). The experience of forming a therapeutic relationship from the client’s perspective. Psychotherapy Research, 28(2), 281-296. doi:10.1080/10503307.2016.1208373. DOI: https://doi.org/10.1080/10503307.2016.1208373
Núñez, L., Midgley, N., Capella, C., Alamo, N., Mortimer, R. & Krause, M. (2021). The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists. Psychotherapy Research, 31(8), 988-1000. doi:10.1080/10503307.2021.1876946. DOI: https://doi.org/10.1080/10503307.2021.1876946
Papalia D. E., & Martorell, G. (2015). Experience Human Development (13th ed.). McGraw-Hill Education.
Principe, J. M., Marci, C. D., Glick, D. M., & Ablon, J. S. (2006). The relationship among patient contemplation, early alliance, and continuation in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 43(2), 238. doi:10.1037/0033-3204.43.2.238. DOI: https://doi.org/10.1037/0033-3204.43.2.238
Roussos, A. J., Gómez-Penedo, J. M. y Muiños, R. (2016). A time-series analysis of therapeutic alliance, interventions, and client’s clinical status in an evidence-based single-case study: Evidence for establishing change mechanisms in psychotherapy. Psychotherapy Research. doi:10.1080/10503307.2016.1174346. DOI: https://doi.org/10.1080/10503307.2016.1174346
Shirk, S. R., & Karver, M. S. (2011). Alliance in child and adolescent psychotherapy. In Norcross, J. (Ed.), Therapeutic relationships that work: Evidence-Based Responsiveness (pp. 70-91). New York: Oxford University Press. DOI: https://doi.org/10.1093/acprof:oso/9780199737208.003.0003
Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review. Journal of Consulting and Clinical Psychology, 71(3), 452. doi:10.1037/0022- 006X.71.3.452. DOI: https://doi.org/10.1037/0022-006X.71.3.452
Titscher, M., Meyer, M., Wodak, R., & Vetter, E. (2000). Methods of Text and Discourse Analysis: In Search of Meaning. London: SAGE Publications Ltd. DOI: https://doi.org/10.4135/9780857024480
Weisz, J., Yi Ng, M., Rutt, C., Lau, N. & Masland, S. (2013). Psychotherapy for children and adolescents. In M.J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 541-586). New York: John Wiley & Sons.
Wilmots, E., Midgley, N., Thackeray, L., Reynolds, S., & Loades, M. (2019). The therapeutic relationship in Cognitive Behaviour Therapy with depressed adolescents: A qualitative study of good-outcome cases. Psychology and Psychotherapy: Theory, Research and Practice, 93(2), 1-16. doi:10.1111/papt.12232. DOI: https://doi.org/10.1111/papt.12232
Zandberg, L. J., Skriner, L. C., & Chu, B. C. (2015). Client‐therapist alliance discrepancies and outcome in cognitive‐behavioral therapy for youth anxiety. Journal Clinical Psychology, 71(4), 313-322. doi:10.1002/jclp.22167. DOI: https://doi.org/10.1002/jclp.22167
Zorzella, K., Rependa, S., Muller. R. (2017). Therapeutic alliance over the course of child trauma therapy from three different perspectives. Child Abuse & Neglect, 67, 147-156. doi:10.1016/j.chiabu.2017.02.032. DOI: https://doi.org/10.1016/j.chiabu.2017.02.032

How to Cite

Nuñez, L., Fernández, S., Alamo, N., Midgley, N., Capella, C., & Krause, M. (2022). The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(1). https://doi.org/10.4081/ripppo.2022.556

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