This research was supported in part by National Institute of Mental Health Grant MH44042 and MH64484. We thank the participating children and their families and the dedicated independent coders: Bianca Barcan, Kasey Carr, Cassandra Cassaro, Celanie Chenet-Norfleet, Stephanie Dobbins, Bernadette Emore, Lori Hirsh, Megan Kuhn-McKearin, Tori Lodge, Melissa Marco, Jessica Mullery, and Anne Schmolze.
Therapist responsiveness to child engagement: flexibility within manual-based CBT for anxious youth†
Version of Record online: 23 APR 2009
© 2009 Wiley Periodicals, Inc.
Journal of Clinical Psychology
Volume 65, Issue 7, pages 736–754, July 2009
How to Cite
Chu, B. C. and Kendall, P. C. (2009), Therapist responsiveness to child engagement: flexibility within manual-based CBT for anxious youth. J. Clin. Psychol., 65: 736–754. doi: 10.1002/jclp.20582
- Issue online: 20 MAY 2009
- Version of Record online: 23 APR 2009
- psychotherapy process;
- therapist flexibility;
- client involvement
Therapy process research helps delineate common and specific elements essential to positive outcomes as well as develop best practice training protocols. Child involvement and therapist flexibility were rated in 63 anxious youth (ages 8–14) who received cognitive–behavioral therapy. Therapist flexibility, defined as therapist attempts to adapt treatment to a child's needs, was hypothesized to act as an engagement strategy that serves to increase child involvement during therapy. Flexibility was significantly related to increases in later child engagement, which subsequently predicted improvement in posttreatment diagnosis and impairment. Therapist flexibility was not associated with earlier measures of child engagement, so a mediation model could not be supported. It was also hypothesized that the impact of flexibility would be greatest for cases who began treatment highly disengaged (i.e., early involvement would moderate the effect of flexibility). Basic descriptive data supported this model, but formal analyses failed to confirm. Further descriptive analyses suggest therapists employ a range of adaptations and a profile of flexible applications within a manual-based treatment is provided. Treatment, measurement, and dissemination issues are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol: 65: 1–19, 2009.