Objectives: 1. To examine baseline therapist characteristics related to alliance. 2. To assess the contribution of alliance to change in treatment outcomes.
Methods: Thirty-four youth (9 – 16 years; 23 male), primarily with ASDs, in a 6-week summer SSI with an explicit focus on fostering child-therapist relationships (Lerner, Mikami, & Levine, 2011) completed reports of their social skills (Social Skills Rating System; Gresham & Elliott, 1990) and social anxiety (Social Anxiety Scales; La Greca, 1999) immediately before and after the SSI. Additionally, they completed blinded sociometric ratings of their peers in their SSI group (Coie, Dodge, & Coppotelli, 1982), and alliance with group therapist (Therapeutic Alliance Scale for Children; Shirk & Saiz, 1992) after the first (early) and last (endpoint) week of the program. Their parents completed a baseline measure of child autism symptoms (Social Responsiveness Scale; Constantino & Gruber, 2005).
Results: Hierarchical Linear Modeling was used to control for nesting within therapists, and past experience with the rated therapist was controlled in all models. To assess Objective 1, after controlling for therapist gender and education, years of therapist experience with ASDs predicted higher early alliance (β04 = .11, p <.01), and therapist age predicted lower early alliance (β02 = -.02, p = .03). To assess Objective 2, after controlling for child autistic symptoms and early sociometric ratings, early alliance predicted increased friendship (β10 = .21, p < .01) and reciprocated friendship nominations (β10 = .15, p = .01), but not social preference (β10 = -0.01, p = .91). Additional analyses for Objective 2 were unavailable at time of submission, but will be available for conference presentation.
Conclusions: Therapist experience with ASDs predicted higher early child alliance, while therapist age predicted lower early alliance. Additionally, youth reporting higher early alliance increased in the number of reciprocated friends they made in the SSI relative to those with lower early alliance. These results suggest that alliance may play a role in friendship-making in SSIs for ASD populations, but vary based on therapist characteristics. Additional analyses predicting therapeutic change may augment these initial promising findings. Future research should expand upon this initial investigation into this underexplored treatment mechanism in SSIs for ASD populations.
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