Therapeutic Alliance Formation for Adolescents and Young Adults with Autism: Relation to Treatment Outcomes and Client Characteristics.
Alexis M Brewe, Carla A Mazefsky, Susan W White
PMID 32737670WHAT IT FOUND
Stronger therapeutic alliance predicted better outcomes for low mood and motivation, but not for emotional reactivity.
Alliance was weaker in clients with higher depression or autism severity. Early alliance quality specifically predicted later mood improvements.
Key findings
01Stronger overall therapeutic alliance predicted reduced posttreatment dysphoria (low positive affect/motivation), but did not predict reduced reactivity.
02Alliance at the beginning of treatment (Time 1) uniquely predicted posttreatment dysphoria outcomes.
03Clients with more co-occurring depression symptoms or higher autism severity had weaker overall therapeutic alliances.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample was small (37 participants) and relatively homogeneous, limiting generalizability. The study used an open trial design without a control group, so it cannot determine if alliance causes improvement or if clients who improve form better alliances. The Vanderbilt Therapeutic Alliance Scales (VTAS-R-SF) has not been validated specifically for ASD, and one item regarding agenda-setting was removed because it did not fit the manualized nature of the therapy. Outcomes were based on parent report, which may differ from the client's own experience. Coders were not blind to the session number, which could introduce bias, although precautions were taken.
Declared interests
The authors have no conflicts of interest.
The easy way to misread this
Do not conclude that improving therapeutic alliance will reduce emotional reactivity or outbursts. The study found that while alliance predicted improvements in dysphoria (low mood/motivation), it was not associated with changes in reactivity. Additionally, because this was an open trial without a control group, it shows an association, not necessarily that the alliance caused the symptom improvement.