Defense Date


Document Type


Degree Name

Master of Science


Clinical Psychology

First Advisor

Bryce McLeod


Alliance and client involvement are thought to be important therapy process factors in child psychotherapy; however, few studies have investigated them over the course of treatment. The present study examined change in alliance, client involvement, and the relationship between the two over time in an effectiveness study comparing cognitive behavioral therapy (CBT) and usual clinical care (UC) for child anxiety disorders. The sample included 40 clinically-referred children (57.50%, female, mean age = 10.81, SD = 2.11, 35.00% Caucasian, 32.50% Latino/Hispanic, 5.00% African-American, 7.50% mixed ethnicity, 20.00% not reported) and 39 therapists employed by community clinics. Two doctoral-level students comprised the coding teams for each measure and independently rated alliance and client involvement in all available recorded sessions. Unconditional multilevel growth models indicated alliance and client involvement did not significantly change over time. Findings suggest that when measured by observational coders, initial levels of alliance and client involvement remain relatively stable throughout different treatments for child anxiety in community settings. Existing therapy process models may require further specification based on treatment setting and method of measurement. In practice, these findings suggest strategies to bolster initial alliance and client involvement could help improve the impact and delivery of child anxiety treatment in community settings.


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Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2013