Therapeutic alliance over the course of child trauma therapy from three different perspectives.

In a multi-site, controlled study with follow up, we looked at the therapeutic alliance in child trauma therapy. Parent, child, and therapist ratings were used to examine how therapeutic alliance changes over the course of Trauma Focused Cognitive Behavior Therapy (TF-CBT), an intervention that uses an exposure based method called a trauma narrative. Participants were 65 children and their caregivers in a community based trauma therapy program in Canada. Children in treatment underwent TF-CBT, including the trauma narrative asking them to write out and process their trauma story in detail. Results indicated that despite how hard it was for children to participate in this intensive treatment method, children, therapists and parents reported positive ratings of the therapeutic alliance throughout treatment. Furthermore, child and therapist's ratings of alliance became significantly more positive from therapy start to finish.