Exploring the Therapeutic Alliance in Cognitive-Behavior Therapy with Children with Autism Spectrum Disorder: An Interpretative Phenomenological Approach
Abstract
The therapeutic alliance (TA) is the most studied process of adult psychotherapeutic change
(Zack et al., 2007) and has been found to have a moderate but robust relationship with
therapeutic outcome regardless of treatment modality (Horvath, 2001). The TA is loosely
described as the extent to which the therapist and the participant connect emotionally and work
together towards goals. Conceptualizations of the TA with children have relied on adult models,
even though it is widely acknowledged that the pediatric population will rarely willingly commit
to therapy, nor readily admit to any challenges that they may be experiencing (Keeley, Geffken,
McNamara & Storch, 2011). For children with Autism Spectrum Disorder (ASD) the
therapeutic alliance may require an even greater retheorizing considering the communicative
and social difficulties of this particular population. Despite this need, research on children with
ASD and the therapeutic TA is almost non-existent. In this qualitative study, transcripts from
semi-structured interviews with mothers of children with ASD were analyzed using
Interpretative Phenomenological Analysis (IPA). IPA closely examines how individual people
make sense of their life experiences using a theme-by-theme approach. The three interviewees
were mothers whose children were participants in a nine-week Cognitive Behaviour Therapy
(CBT) group for obsessive-compulsive behaviours (OCB). A total of four superordinate themes
were identified: (i) Centralization and disremembering the TA, (ii) Qualities of the therapist,
(iii) TA and the importance of time, and (iv) Signs of a healthy TA. The mothers’ perspectives
on the TA suggest that, for them and their children, a strong TA was a required component of
the therapy. Implications for clinicians and researchers are discussed