The working alliance inventory - short version: psychometric properties of the patient and therapist form in youth mental health and addiction care.

The therapeutic alliance is considered to play an important role in youth treatment. The commonly used versions of the Working Alliance Inventory (WAI) are based on Bordin's three-dimensional alliance model. However, previous psychometric studies of the WAI did not find this three-dimensional structure in youth psychotherapy. These earlier findings may indicate different perceptions of the alliance by adolescent versus adult patients, but may also be due to methodological shortcomings. The current study aims to address previous study limitations by evaluating the factor structure of the short version of the WAI (WAI-S) in youth treatment in multilevel analysis to address the hierarchical structure of the alliance data. We examined the psychometric properties of the patient (n = 203) and therapist (n = 62) versions of the WAI-S in youth mental health and addiction care and tested four multilevel models of alliance at start of treatment and 2-month follow-up. Our results suggests a two-factor model for youth and a three-dimensional model for their therapist at both time points. Since this is the first study that finds a best fit for a two-dimensional construct of alliance in youth, more research is needed to clarify whether the differences in alliance dimensions are due to measurement differences between the WAI-S for youth and therapists or whether youth and their therapists truly differ in their perceptions of the concept of alliance.

Systematic Client Feedback in Youth Mental Health and Addiction Care: A Controlled Study Comparing Two Treatment Cohorts.

INTRODUCTION: We investigated the value of systematic client feedback in youth mental health and addiction care. In the present study, we examined whether a client feedback intervention would result in improved therapeutic alliance and treatment outcomes. METHODS: Two hundred and four adolescents participated in the study using a - non-randomized - between-group A/B design. In the first study group, 127 patients were offered 4 months of treatment as usual (TAU), and in the second study group, 77 patients received the client feedback intervention as an add-on to TAU during 4 months. RESULTS: Youths who received systematic client feedback in addition to TAU did not show better treatment outcomes or better alliance ratings after 4 months than youths receiving TAU only. Sensitivity analyses, in which we compared the more adherent patients of the second study group with patients receiving TAU, did not show significant beneficial effects of client feedback either. Also, the client feedback intervention did not result in lower rates of early treatment drop-out. DISCUSSION/CONCLUSION: Our results cautiously suggest that client feedback does not have incremental effects on alliance and the treatment outcome for youth in mental health and addiction treatment. Moreover, our study highlights the challenges of implementing client feedback in clinical practice and the need for additional research addressing these challenges.

A dual perspective on first-session therapeutic alliance: strong predictor of youth mental health and addiction treatment outcome.

We investigated the potential role of first-session therapeutic alliance ratings to serve as an early marker of treatment outcome in youth mental health and addiction treatment. The present study is among the first to incorporate both a youths' and a therapists' perspective of the therapeutic alliance in order to maximize predictive value of the alliance for treatment outcome. One hundred and twenty-seven adolescents participated in a multi-site prospective naturalistic clinical cohort study, with assessments at baseline and at 4 months post-baseline. Main outcome measure was favorable or unfavorable treatment outcome status at 4-month follow-up. Early therapeutic alliance had a medium and robust association with treatment outcome for youth' (b = 1.29) and therapist' (b = 1.12) perspectives and treatment setting. Based on the two alliance perspectives four subgroups were distinguished. Incorporating the alliance-ratings from both perspectives provided a stronger predictor of treatment outcome than using one perspective. Youth with a strong alliance according to both perspectives had an eightfold odds of favorable treatment outcome compared with youth with a weak alliance according to both perspectives. The association between therapeutic alliance and treatment outcome in youth mental health and addiction treatment may be substantially stronger than earlier assumed when both a youths' and therapists' perspective on alliance is considered.

Motivational and control mechanisms underlying adolescent cannabis use disorders: A prospective study.

Cannabis use disorders (CUDs) are the most prevalent substance use disorders among adolescents in treatment. Yet, little is known about the neuropsychological mechanisms underlying adolescent CUDs. Studies in adult cannabis users suggest a significant role for cognitive control and cannabis-oriented motivational processes, such as attentional bias, approach bias, and craving in CUDs. The current 6-month prospective study investigated the relationships between attentional bias, approach bias, craving, cognitive control, and cannabis use in adolescent patients in treatment for a primary or secondary CUD. Moreover, we investigated if these motivational processes and cognitive control could predict treatment progression after 6 months. Adolescents with a CUD had an attentional but no approach bias towards cannabis. In contrast to adult findings on the role of attentional bias, approach bias and cognitive control, only cannabis craving significantly correlated with current cannabis use and predicted cannabis use-related problems and abstinence from cannabis 6 months later. These findings identify craving as a predictor of treatment outcome, thereby supporting an important role for craving in the course of adolescent cannabis use and dependence. This prospective study is among the first to investigate neuropsychological mechanisms underlying adolescent CUDs, warranting future longitudinal studies.