Reviewgreen2021

Review: Therapist factors and their impact on therapeutic alliance and outcomes in child and adolescent mental health – a systematic review

Rachael Ryan · Katherine Berry · Samantha Hartley

60 citations0/0 files storedChild and Adolescent Mental Health

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Psychotherapy Techniques and Applications Psychoanalysis and Psychopathology Research Counseling Practices and Supervision

Abstract

BACKGROUND: Young people's mental health is a significant concern globally. The evidence suggests that there is a strong relationship between therapeutic alliance and children's reported outcomes such as symptoms and dropout of services. There are indications that therapist characteristics - including static qualities and dynamic behaviours - can be associated with both alliance and outcomes. METHOD: The aim of this review was to systematically collate, summarise and critique studies reporting on therapist characteristics that might influence the therapeutic alliance or outcomes for young people accessing child and adolescent mental health services. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed, and four databases (PsycINFO, PsycARTICLES, MEDLINE and CINAHL) were searched for 'therapist' and 'characteristic' combined with 'alliance' or 'outcome' and related terms associated with these topics. RESULTS: A review of 15 papers showed that therapists' in-session behaviours and interpersonal style have a significant impact on alliance or outcome. One study also indicated important associations with attachment style. Findings related to ethnicity, gender and level of experience were complex; highlighting differences between subgroups, ages, outcome measurement and diagnostic categories. Methodological issues such as secondary analysis on administrative data confounded the interpretation of results. CONCLUSIONS: There are indications that specific therapist factors can impact on alliance and outcomes in child and adolescent mental health services. Future research needs to adopt a prospective design and measure therapist characteristics and their relationship to alliance or outcome over time in a broad range of settings.

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2009Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement 1983A Children's Global Assessment Scale (CGAS)2004A Process for Systematically Reviewing the Literature: Providing the Research Evidence for Public Health Nursing Interventions 2000Manual for the ASEBA preschool forms and profiles 2003A review of therapist characteristics and techniques positively impacting the therapeutic alliance 2015Cognitive behavioural therapy for anxiety disorders in children and adolescents 2003Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review.2011Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes.

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