Therapeutic alliance in child psychotherapy: adaptation of an instrument and validity evidence
DOI:
https://doi.org/10.34019/1982-1247.2025.v19.42705Keywords:
Intrument adaptation, Therapeutic alliance, Children, Psychodynamic psychotherapy, TPOCS-AAbstract
Therapeutic alliance is an important element of the therapeutic process. To be analyzed it requires valid and reliable instruments. This study aimed to develop a cross-cultural adaptation of the Therapy Process Observational Coding System for Child Psychotherapy - Alliance Scale (TPOCS - A) into Brazilian Portuguese, examining its reliability and evidence of validity. The Brazilian version presented good semantic, idiomatic, experiential, and conceptual equivalence, evaluator’s reliability, good internal consistency, and evidence of convergent validity. Factor analysis resulted in a solution of one factor, like international studies, proving to be a valid and reliable instrument for analyzing the therapist-patient alliance.
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References
Ary, D., Jacobs, L. C., & Razavieh, A. (2010). Introduction to research in education. Harcout.
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885
Bordin, E. S. (1994). Theory and research on the therapeutic working alliance: New directions. In A. O. Horvath & L. S. Greenberg (Eds.), Wiley series on personality processes. The working alliance: Theory, research, and practice (pp. 13-37). John Wiley & Sons.
Borsa, J. C., Damásio, B. F., & Bandeira, D. R. (2012). Adaptação e validação de instrumentos psicológicos entre culturas: Algumas considerações. Paidéia, 22(53), 423–432. http://dx.doi.org/10.1590/S0103-863X2012000300014
Chethik, M. (2003). Techniques of child therapy: Psychodynamic strategies (2ª ed.). Guilford Press.
Chiu, A. W., McLeod, B. D., Har, K., & Wood, J. J. (2009). Child-therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders. Journal of Child Psychology and Psychiatry, 50, 751–758. https://doi.org/10.1111/j.1469-7610.2008.01996.x
Estrada, A., & Russell, R. (1999). The development of the Child Psychotherapy Process Scales (CPPS). Psychotherapy Research, 9(2), 154–166. https://doi.org/10.1093/ptr/9.2.154
Faw, L., Hogue, A., Johnson, S., Diamond, G. M., & Liddle, H. A. (2005). The Adolescent Therapeutic Alliance Scale (ATAS): Initial psychometrics and prediction of outcome in family-based substance abuse prevention counseling. Psychotherapy Research, 15, 141–154. https://doi.org/10.1080/10503300512331326994
Figueiredo, B., Dias, P., Lima, V. S., & Lamela, D. (2016). Working Alliance Inventory For Children And Adolescents (WAI-CA): Development and psychometric properties. European Journal of Psychological Assessment, 35(1), 22–28. https://doi.org/10.1027/1015-5759/a000364
Fjermestad, K. W., McLeod, B. D., Heiervang, E. R., Havik, O. E., Öst, L. G., & Haugland, B. S. (2012). Factor structure and validity of the therapy process observational coding system for Child Psychotherapy–Alliance Scale. Journal of Clinical Child & Adolescent Psychology, 41(2), 246–254. https://doi.org/10.1080/15374416.2012.651999
Goodman, G., & Athey-Lloyd, L. (2011). Interaction structures between a child and two therapists in the psychodynamic treatment of a child with Asperger’s disorder. Journal of Child Psychotherapy, 37(3), 311–326. https://doi.org/10.1080/0075417X.2011.614749
Goodman, G., Midgley, N., & Schneider, C. (2016). Expert clinicians’ prototypes of an ideal child treatment in psychodynamic and CBT: Is mentalization seen as a common process factor? Psychotherapy Research, 26(5), 590–601. https://doi.org/10.1080/10503307.2015.1049672
Greenson, R. R. (2017). The working alliance and the transference neurosis. The Psychoanalytic Quarterly, 34(2), 155–181. (Original publicado em 1965). https://doi.org/10.1002/j.2167-4086.2008.tb00334.x
Halfon, S. (2021). Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy. Journal of Consulting and Clinical Psychology, 89(2), 96–109. https://doi.org/10.1037/ccp0000620
Greenson, R. R. (2017). The working alliance and the transference neurosis. The Psychoanalytic Quarterly, 34(2), 155–181. (Original publicado em 1965). https://doi.org/10.1002/j.2167-4086.2008.tb00334.x
Halfon, S. (2021). Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy. Journal of Consulting and Clinical Psychology, 89(2), 96–109. https://doi.org/10.1037/ccp0000620
Karver, M. S., Handelsman, J. B., Fields, J. B., & Bickman, L. (2006). Meta-analysis of relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26, 50–65. https://doi.org/10.1016/j.cpr.2005.09.001
Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of consulting and clinical psychology, 62(1), 100–110. https://doi.org/10.1037/0022-006X.62.1.100
Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155–163. https://doi.org/10.1016/j.jcm.2016.02.012
Langer, D. A., McLeod, B. D., & Weisz, J. R. (2011). Do treatment manuals undermine youth–therapist alliance in community clinical practice? Journal of Consulting and Clinical Psychology, 79, 427–432. https://doi.org/10.1037/a0023821
Liber, J. M., Van der Leeden, A. J. M., Sauter, F., & Treffers, P. D. A. (2007). Therapeutische alliantie: de TPOCS-A. Een observatie-codeersysteem voor het beoordelen van de band tussen cliënt en therapeut bij kinderpsychotherapie. Kind en Adolescent, 28, 21–32. https://doi.org/10.1007/BF03061007
McLeod, B. D. (2010). Scoring Manual for the TPOCS-A. (Manuscrito não publicado). Virginia Commonwealth University.
McLeod, B. D. (2011). Relation of the alliance with outcomes in youth psychotherapy: A meta-analysis. Clinical Psychology Review, 31(4), 603–616. https://doi.org/10.1016/j.cpr.2011.02.001
McLeod, B. D., & Weisz, J. R. (2005). The therapy process observational coding system-alliance scale: Measure characteristics and prediction of outcome in usual clinical practice. Journal of consulting and clinical psychology, 73(2), 323–333. https://doi.org/10.1037/0022-006X.73.2.323
Pacico, J. C., Hutz, C. S., Schneider, A. M. A., & Bandeira, D. R. (2015). Validade. In C. S. Hutz, D. R. Bandeira, & C. M. Trentini (Eds.), Psicometria. (pp. 71-84). Artmed.
Ramires, V. R. R. & Schneider, C. (2016). Psicoterapia de Crianças: Desenvolvimento da Versão em Português do Child Psychotherapy Q-Set. Psicologia: Teoria e Pesquisa (Brasília. Online), 32(3), 1–10. http://dx.doi.org/10.1590/0102-3772e323218
Roest, J., Helm, P., van der, Strijbosch, E., Brandenburg, M., van, & Stams, G. J. (2016). Measuring therapeutic alliance with children in residential treatment and therapeutic day care: A validation study of the Children’s Alliance Questionnaire. Research on Social Work Practice, 26(2), 212–218. https://doi.org/10.1177/1049731514540478
Schmidt, F. D., Gastaud, M. B., & Ramires, V. R. R. (2018). Interaction structures in the psychodynamic psychotherapy of a girl diagnosed with adjustment disorder. Temas em Psicologia, 26(2), 719–734. https://doi.org/10.9788/tp2018.2-07pt Schneider, C., & Jones, E. E. (2012). Appendix IB. Child Psychotherapy Q-Set. Coding Manual. In R. A. Levy, J. S. Ablon, & H. Kächele (Eds), Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence. (pp 611–626). Humana Press.
Shelef, K., & Diamond, G. M. (2008). Short form of the revised Vanderbilt Therapeutic Alliance Scale: Development, reliability, and validity. Psychotherapy Research, 18(4), 433–443. https://doi.org/10.1080/10503300701810801
Shirk, S. R., & Saiz, C. C. (1992). Clinical, empirical, and developmental perspectives on the therapeutic relationship in child psychotherapy. Development and Psychopathology, 4(4), 713–728. https://doi.org/10.1017/S0954579400004946
Shirk, S. R., Karver, M. S., & Brown, R. (2011). The alliance in child and adolescent psychotherapy. Psychotherapy, 48, 17–24. https://doi.org/10.1037/a0022181
Zanon, C., & Hauck, N. (2015). Fidedignidade. In C. S. Hutz, D. R. Bandeira, & C. M. Trentini (Eds.), Psicometria (pp. 85–96). Artmed.










