Therapeutic alliance within trauma-focused cognitive behavioral therapy: A systematic review

Abstract

The purpose of this study was to perform a systematic review to describe the empirical support on TF-CBT and therapeutic alliance. Three electronic databases (PsychInfo, Web of Science, and SCOPUS) were searched through October 2023. Quantitative studies containing TF-CBT and measures of alliance were included. A total of 3,036 studies were screened, resulting in 15 quantitative studies being included in the review and charted. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields tool was used to check quality. Results suggest the importance of building early alliance, highlight differences in alliance perspectives between raters, and emphasize the strong influence caregivers have on children’s perceptions of treatment. The review is limited by moderate-to-weak methodological rigor among studies and a relatively small number of studies available for review indicating the need for future methodologically rigorous research on this topic. This work did not receive funding, and authors have no conflicts of interest to declare.

Plain Language Summary

Treating childhood trauma with trauma-focused cognitive behavioral therapy (TF-CBT) can significantly improve mental health for both children and parents, reducing trauma symptoms and increasing satisfaction. This review looked at how the relationship between therapists and children, known as therapeutic alliance, affects TF-CBT outcomes. It found that early positive connections between therapists and children are crucial. However, there were differences in how therapists, children, and caregivers rated these relationships. Caregivers’ support also plays a significant role in how children perceive treatment and respond to it. The review noted that while these findings are important, many studies had methodological limitations and few were available for review.