According to a new study, manual guided treatment actually enhances the therapist-client alliance initially, but has no advantageous impact on therapeutic outcome over time. David A. Langer of the University of California, Los Angeles, Bryce D. McLeod of Virginia Commonwealth University and John R. Weisz of Harvard University and Judge Baker Children’s Center, collaborated on a study in order to dispel the growing concern that treatment manuals that guide therapists in the delivery of therapy, impede the important alliance between client and therapist that is fundamental to an effective outcome. “Alliance, as typically defined, encompasses the affective and collaborative aspects of the client-therapist relationship,” said the team. “Alliance may play a critical role in both behavioral and non-behavioral treatments for youths because youths rarely self-refer and may resist engaging in treatment. The researchers followed 76 young people from local mental health clinics who were part of the Youth Anxiety and Depression Study to determine their results. They used the Primary and Secondary Control Enhancement Training (PASCET) and the Coping Cat (CC) to evaluate depression and anxiety in the participants.
The youths were divided into two groups. The first group received manual guided treatment for an average of 17 sessions. The second group received usual care, given by therapists through traditional methods that they had used before and had deemed effective. The researchers discovered that early in the treatment, the manually guided youths reported a much higher level of alliance than the usual care group. However, the alliance converged during the middle and end of the treatment phase. “One possible interpretation of these findings is that using treatment manuals may enhance alliance early in therapy,” said the researchers. “Perhaps youths respond well to early structure and clear treatment agendas of manualized treatments.” Because youths are usually resistant to treatment, the team believes their findings are important. They added, “Thus, a critical task for therapists is to build enough of an alliance early in treatment to engage youths in the treatment process.”
Langer, David A., Bryce D. McLeod, and John R. Weisz. “Do Treatment Manuals Undermine Youth–Therapist Alliance in Community Clinical Practice?” Journal of Consulting and Clinical Psychology 79.4 (2011): 427-432. Print.
© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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