Therapeutic Alliance in Parent-Focussed Interventions for Youth Depression by Julian Andrew ...

252 Pages·2016·3.07 MB·English

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Therapeutic Alliance in Parent-Focussed Interventions for Youth Depression
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Julian Andrew Thompson
BA(Journ), BSci(Hons), GradDipPsych, PGradDipPsych

Submitted in partial fulfilment of the requirements for the degree of
Doctor of Psychology (Clinical)

Deakin University
March, 2016

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Acknowledgements
Firstly I would like to sincerely thank my supervisor, Associate Professor Tess Knight.
I could not have wished for a more supportive, encouraging and understanding supervisor.
Your knowledge, guidance, and attentiveness throughout my entire doctorate were invaluable
and thoroughly appreciated, thank you.
I would also like to thank Professor John Toumbourou, who also provided invaluable
guidance and support.
Heartfelt thanks to my partner, Sandra, whose support and understanding throughout
my studies have literally made all of this possible. I am grateful for everything you have done
and I could not have done this without you.
Finally, thank you to my wonderful father, who has been a constant source of
unwavering love and support for my entire life. Your intelligence, wisdom, and guidance
have provided me with more than words can say, I love you and I dedicate this thesis to you.

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TABLE OF CONTENTS
Acknowledgements ............................................................................................................... i(cid:1)
TABLE OF CONTENTS ................................................................................................... ii(cid:1)
LIST OF TABLES ............................................................................................................... v(cid:1)
LIST OF FIGURES .......................................................................................................... vii(cid:1)
LIST OF ABREVIATIONS ............................................................................................. vii(cid:1)
Abstract ................................................................................................................................ xi(cid:1)
Overview Of Thesis .......................................................................................................... xiii(cid:1)
CHAPTER ONE ...................................................................................................................... 1(cid:1)
The Historical and Theoretical Development of the Therapeutic Alliance .................... 1(cid:1)
CHAPTER TWO ..................................................................................................................... 8(cid:1)
The Measurement of the Therapeutic Alliance ................................................................. 8(cid:1)
CHAPTER THREE ............................................................................................................... 14(cid:1)
The Role of the Therapeutic Alliance in Individual Adult Therapy ............................. 14(cid:1)
CHAPTER FOUR .................................................................................................................. 18(cid:1)
The Therapeutic Alliance Over Time and its Relationship to Treatment Outcomes .. 18(cid:1)
CHAPTER FIVE ................................................................................................................... 24(cid:1)
The Role of the Therapeutic Alliance in Youth Therapy ............................................... 24(cid:1)
CHAPTER SIX ...................................................................................................................... 31(cid:1)
Therapeutic Alliance and Group Cohesion in Group Therapy ..................................... 31(cid:1)
CHAPTER SEVEN ................................................................................................................ 39(cid:1)
Qualitative Research into Therapeutic Alliance ............................................................. 39(cid:1)
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CHAPTER EIGHT ................................................................................................................ 48(cid:1)
The Role of Families in Youth Mental Health and Treatment ...................................... 48(cid:1)
Youth Mental Health Treatment: Family and Parent-Focussed Interventions ................ 50(cid:1)
The Theoretical Basis of Family- and Parent-based Treatments of Youth Mental Health
Problems .......................................................................................................................... 51(cid:1)
The Efficacy of Family and Parent-focussed Interventions in the Treatment of Youth
Mental Health Issues ........................................................................................................ 55(cid:1)
CHAPTER NINE ................................................................................................................... 65(cid:1)
Parent Therapeutic Alliance in Youth Mental Health Treatment and Parent-Focussed
Interventions ....................................................................................................................... 65(cid:1)
CHAPTER TEN ..................................................................................................................... 77(cid:1)
Study 1. Quantitative Analysis of the Relationship Between Ratings of Alliance and
Changes In Youth Depression in Parent Focussed Interventions ................................. 77(cid:1)
Study Background and Rationale ..................................................................................... 77(cid:1)
Aims and Hypotheses ...................................................................................................... 79(cid:1)
Method ................................................................................................................................ 80(cid:1)
Participants ....................................................................................................................... 80(cid:1)
Measures .......................................................................................................................... 82(cid:1)
Procedure ......................................................................................................................... 83(cid:1)
Behaviour Exchange and Systems Therapy – MOOD .................................................... 85(cid:1)
Parenting Adolescents Support Training (PAST) ............................................................ 93(cid:1)
Analysis Plan ................................................................................................................... 96(cid:1)
Preparation of Data .......................................................................................................... 98(cid:1)
Results ................................................................................................................................. 98(cid:1)
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Group Differences in Working Alliance Inventory Measures ......................................... 98(cid:1)
Alliance Between Facilitators and Parents ...................................................................... 99(cid:1)
Alliance Between Facilitators and Young People ......................................................... 106(cid:1)
Treatment Effects On Young Person Depressive Symptoms ........................................ 106(cid:1)
Relationship Between Alliance and Changes in Young Person Depressive Symptoms 109(cid:1)
Discussion .......................................................................................................................... 117(cid:1)
Summary of Findings ..................................................................................................... 117(cid:1)
Pattern of Alliance Over Time ....................................................................................... 119(cid:1)
Predictive Relationship Between Linear Pattern of Alliance and Depression Changes in
Young People ................................................................................................................. 121(cid:1)
The Association of Early- and Mid-treatment Alliance scores with Depression Changes
in the Young People ....................................................................................................... 123(cid:1)
Associations Between Different Raters of Alliance ...................................................... 127(cid:1)
Final Comments, Limitations, and Further Considerations ........................................... 128(cid:1)
CHAPTER ELEVEN ........................................................................................................... 130(cid:1)
Study 2. A Qualitative Analysis of the Parent’s Experience of the Therapeutic
Alliance and it’s Relationship with Therapeutic Processes and Outcomes ................ 130(cid:1)
Study 2 Aims .................................................................................................................. 130(cid:1)
Method .............................................................................................................................. 130(cid:1)
Participants ..................................................................................................................... 130(cid:1)
Materials ........................................................................................................................ 131(cid:1)
Procedure ....................................................................................................................... 132(cid:1)
Data Analysis ................................................................................................................. 133(cid:1)
Results ............................................................................................................................... 136(cid:1)
The Alliance and Opening Up ....................................................................................... 136(cid:1)
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Intervention Matters ....................................................................................................... 141(cid:1)
Familial Historical Context ............................................................................................ 154(cid:1)
Discussion .......................................................................................................................... 159(cid:1)
Final Comments, Limitations, and Further Considerations ........................................... 169(cid:1)
CHAPTER TWELVE ......................................................................................................... 171(cid:1)
General Discussion ........................................................................................................... 171(cid:1)
Chapter Summary .......................................................................................................... 171(cid:1)
Summary of Findings and Overview of Results ............................................................ 171(cid:1)
Study Limitations and Further Considerations .............................................................. 179(cid:1)
Conclusion ..................................................................................................................... 186(cid:1)
References ......................................................................................................................... 188(cid:1)
Appendix A – Ethics Approval Letter For Family Options Study .............................. 221(cid:1)
Appendix B – Session Handouts for BEST Intervention ............................................. 222(cid:1)
Appendix C – Session Handouts for PAST Intervention ............................................. 227(cid:1)
LIST OF TABLES
Table 1 ..................................................................................................................................... 99(cid:1)
Summary of One-way Analysis of Variance of Total Alliance by Intervention Received (BEST
and PAST) ................................................................................................................................ 99(cid:1)
Table 2 ................................................................................................................................... 102(cid:1)
Descriptive Statistics for Facilitator Alliance Aggregated From All Weeks of Treatment ... 102(cid:1)
Table 3 ................................................................................................................................... 104(cid:1)
Means, Standard Deviations, Effect Sizes for Differences Between Alliance Scores, and
Correlations Between Parent and Facilitator Alliance Scores in Week 2 ............................. 104(cid:1)
Table 4 ................................................................................................................................... 105(cid:1)
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Means, Standard Deviations, Effect Sizes for Differences Between Alliance Scores, and
Correlations for Parent and Facilitator Alliance Scores in Week 5 ..................................... 105(cid:1)
Table 5 ................................................................................................................................... 107(cid:1)
Means, Standard Deviations, Effect Sizes for Differences Between Alliance Scores, and
Correlations for Young Person and Facilitator Alliance Scores in Week 5 .......................... 107(cid:1)
Table 6 ................................................................................................................................... 108(cid:1)
One-way Analysis of Variance of Pre-, Post-, and Follow-up-SMFQ scores by Intervention
Received (BEST and PAST) ................................................................................................... 108(cid:1)
Table 7 ................................................................................................................................... 109(cid:1)
Means, Standard Deviations, and Effect Sizes for Differences Between Pre-, Post- and
Follow-up-SMFQ Measures .................................................................................................. 109(cid:1)
Table 8. .................................................................................................................................. 112(cid:1)
Pearson Correlations Between Week 2 Facilitator Alliance with Parents, Parent Alliance,
and Young Person Depressive ............................................................................................... 112(cid:1)
Symptom Changes .................................................................................................................. 112(cid:1)
Table 9. .................................................................................................................................. 113(cid:1)
Pearson Correlations Between Week 5 Facilitator Alliance with Parents, Parent Alliance,
and Young Person Depressive ............................................................................................... 113(cid:1)
Symptom Changes .................................................................................................................. 113(cid:1)
Table 10. ................................................................................................................................ 114(cid:1)
Intercorrelations Between Week 5 Facilitator Alliance with Young People, Young Person
Alliance, and Young ............................................................................................................... 114(cid:1)
Person Depressive Symptom Changes ................................................................................... 114(cid:1)
Table 11. ................................................................................................................................ 116(cid:1)
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Logistic Regression Analysis of Alliance Measures on Young Person Depressive Symptom
Changes .................................................................................................................................. 116(cid:1)
LIST OF FIGURES
Figure 1. Flow chart of enrolment, allocation, post-treatment, follow-up and analysis
phase of the Family Options trial. ....................................................................................... 84(cid:1)
Figure 2. Curve estimations for facilitator total-, task-, goal-, and bond-ratings of
parent alliance for sessions one to eight of treatment. ................................................... 98(cid:1)
Figure 3. Average facilitator total-, task-, goal-, and bond-ratings of parent alliance
for weeks one to eight of treatment. ................................................................................... 99(cid:1)
Figure 4. Plot showing those parents whose child’s post-treatment depressive
symptoms reduced by 5 or more points on the short moods and feelings
questionnaire (measurable change) versus those parents whose child’s post-
treatment depressive symptoms increased or did not change. ................................... 112(cid:1)
LIST OF ABREVIATIONS
ADHD - Attention-deficit/Hyperactivity Disorder
ANOVA - Analysis of Variance
AOD - Alcohol and Drug
AOR - Adjusated Odds Ratio
ASDs - Austism Spectrum Disorders
BD - Bipolar Disorder
BEST - Behaviour Exchange Systems Training
CALPAS - California Psychotherapy Alliance Scales
CBT - Cognitive Behavioural Therapy
CT - Cognitive Therapy
CYMHS - Child and Youth Mental Health Service
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