RESUMO
Background: Caregivers play a key role in the success of trauma-focused cognitive behavioural therapy (TF-CBT). Yet, the effect of their alliance on treatment outcomes besides the other parties in treatment has hardly been studied. Objective: This study examined the working alliance (WA) of therapists, patients and caregivers in TF-CBT and its contribution on treatment outcome over time. Methods: N = 76 children and adolescents (mean age = 12.66 years, range 7-17, M/F ratio: .43) participated in the TF-CBT arm of a randomized controlled trial. The WA was assessed with the Working Alliance Inventory Short Version (WAI-S) at two measurement points, while symptom level of posttraumatic stress symptoms (PTSS) was assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Paired sample t-tests, intraclass correlations (ICC), and mixed-effects regression models for longitudinal data were performed. Results: The alliance rating was high across all informants, with caregivers achieving the highest rating. The average level of cross-informant agreement on the alliance was low between therapists and caregivers (ICC = .26) and moderate between therapists and patients (ICC =.65). A significant contribution of an alliance improvement to the reduction of PTSS over time was found in each of the two tested models: therapists with patients model (b = .682) and therapists with caregivers model (b = .807). However, these effects were not detected with all four perspectives in one comprehensive model. Conclusion: In summary, the potential of caregivers' views should receive more attention in the therapeutic process of trauma-focused therapy.
Antecedentes: los cuidadores desempeñan un papel clave en el éxito de la terapia cognitivo-conductual centrada en el trauma (TF-CBT por sus siglas en inglés). Sin embargo, el efecto de su alianza en los resultados del tratamiento, aparte de los otros participantes en el tratamiento, apenas se ha estudiado.Objetivo: Este estudio examinó la alianza de trabajo (WA por sus siglas en inglés) de terapeutas, pacientes y cuidadores en TF-CBT y su contribución en el resultado del tratamiento a lo largo del tiempo.Métodos: N = 76 niños y adolescentes (edad media = 12,66 años, rango 7-17, relación M/F: 0.43) fueron parte del brazo que recibía TF-CBT en un ensayo controlado aleatorio. La WA se evaluó con la versión abreviada del Inventario de la Alianza de Trabajo (WAI-S por sus siglas en inglés) en dos mediciones, mientras que el nivel sintomático de los síntomas de estrés postraumático (PTSS por sus siglas en inglés) fue evaluado con la Escala de TEPT administrada por el profesional clínico para niños y adolescentes (CAPS-CA por sus siglas en inglés). Se realizaron pruebas t de muestras pareadas, correlaciones intraclase (ICC por sus siglas en inglés) y modelos de regresión de efectos mixtos para datos longitudinales.Resultados: La calificación de la alianza fue alta en todos los informantes, con los cuidadores logrando la calificación más elevada. El nivel promedio de acuerdo entre informantes sobre la alianza fue bajo entre terapeutas y cuidadores (ICC = .26, p = .002) y moderado entre terapeutas y pacientes (ICC = .65, p = <.001). Se encontró una contribución significativa de una mejora de la alianza a la reducción de PTSS a lo largo del tiempo en cada uno de los dos modelos probados: modelo de terapeutas con pacientes (b = .682; p = .039) y modelo de terapeutas con cuidadores (b = .807; p <.001). Sin embargo, estos efectos no se detectaron con las cuatro perspectivas en un modelo integral.Conclusión: en resumen, el potencial de las opiniones de los cuidadores debería recibir más atención en el proceso terapéutico de la terapia centrada en el trauma.
RESUMO
Parents may develop symptoms of distress and dysfunctional cognitions in response to their child's exposure to traumatic events. Additionally, they may also be affected by their own traumatic experiences. This study investigated the frequency of traumatic experiences and of symptoms of posttraumatic stress and depression in a sample of parents of children and adolescents with posttraumatic stress disorder (PTSD). Furthermore, we explored the association of parental symptoms with their dysfunctional cognitions related to their child's trauma. Parents (N = 113) of children and adolescents with PTSD completed the Posttraumatic Diagnostic Scale (PDS), the Beck depression inventory (BDI-II), the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Correlations between symptom measures and dysfunctional cognitions were calculated. The majority (78.8 %) of the parents reported their own potentially traumatic experiences. Furthermore, 33.6 % evaluated their child's trauma as the worst event, 34.5 % rated their own experiences as their worst event, and 26.5 % indicated that their own worst traumatic event was the same type as their child's trauma. The frequency of clinically elevated parental symptoms on the PDS was 48.6 %, and on the BDI-II 32.7 %. Parental symptoms were independent of the reference person of the parental traumatic index event. However, they did correlate significantly with their dysfunctional cognitions (between r = 0.44 and 0.69, p < 0.01). Many parents report their own traumatic experiences and a significant proportion has its own clinically relevant symptoms of distress. Parental psychological symptoms are moderately associated with their dysfunctional cognitions. The results emphasize the need to consider parental distress when treating pediatric PTSD.
