Abstract
Measurement limitations lessen the conclusions about the role of the alliance in youth psychosocial treatment. This article examined the score reliability, factor structure, and validity of the 9-item Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale (TPOCS-A). The sample, 51 youth aged 7-15 years (
= 10.36 years,
= 1.90; 86.3% White; 60.8% male, 39.2% female), met diagnostic criteria for a principal anxiety disorder and received cognitive-behavioral therapy. Treatment sessions (
= 463) were coded by independent coders using the TPOCS-A along with observational measures of treatment adherence and therapist competence. Youth and therapists also completed self-report alliance measures at the end of each session. Reliability estimates, ICC(2,2), at the item level indicated a mean interrater reliability of .68 (
= .10) and a mean coder stability of .64 (
= .11). An exploratory factor analysis identified a one-factor solution with five items. TPOCS-A scores evidenced convergent validity with the therapist and adolescent reports of alliance but did not converge with the child-report alliance measure. TPOCS-A scores evidenced discriminant validity when compared with scores on adherence and competence measures. The reliability and validity profile of the 9- and 5-item versions of the TPOCS-A were similar. Overall, findings support the reliability and validity of the TPOCS-A scores, but questions remain about how best to assess the alliance with children. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
