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

252 Pages·2016·3.07 MB·English
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(cid:1) Therapeutic Alliance in Parent-Focussed Interventions for Youth Depression (cid:1) (cid:1) (cid:1) (cid:1) (cid:4)(cid:21)(cid:1) (cid:1) (cid:1) (cid:1) (cid:1) 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 (cid:9)(cid:1) (cid:9)(cid:1) 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. (cid:1) (cid:9)(cid:9)(cid:1) (cid:9)(cid:9)(cid:1) 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) (cid:1) (cid:9)(cid:9)(cid:9)(cid:1) (cid:9)(cid:9)(cid:9)(cid:1) 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) (cid:1) (cid:9)(cid:18)(cid:1) (cid:9)(cid:18) 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) (cid:1) (cid:18)(cid:1) (cid:18) 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) (cid:1) (cid:18)(cid:9)(cid:1) (cid:18)(cid:9) 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) (cid:1) (cid:18)(cid:9)(cid:9)(cid:1)(cid:18)(cid:9)(cid:9)(cid:1) 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 (cid:1)

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Parent Therapeutic Alliance in Youth Mental Health Treatment and Parent-Focussed reluctant or refuses to engage with mental health services.
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