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- long-term re-arrest rates reduced by median of 42%;
- out-of-home placements, across all studies, reduced by a median of 54%;
- improved families functioning;
- decreased substance use;
- fewer mental-health problems
- higher levels of client satisfaction;
- considerable cost savings.
- High therapist adherence can reduce the number of young people with criminal charges by 36 percent at 2.3 years after treatment;
- high supervisor adherence can reduce the number of young people with criminal charges by 53 percent at 2.3 years after treatment;
- MST has been effectively transported to community practice settings;
- MST currently has more than 500 active programmes;
- adherence measures demonstrate that MST is being delivered with high levels of fidelity;
- outcomes in community practice settings are similar to those of university-based trials.
The Association of Child and Adolescent Mental Health (ACAMH) - Child & Adolescent Mental Health Journal
Background: The client–therapist working alliance is a key contributor to effective adult psychotherapy. However, little is known about its role in family and systemic therapy. Moreover, few studies have assessed alliance longitudinally or have investigated how it interrelates with other process variables, such as therapist adherence (i.e. the extent to which the therapist adheres to the treatment protocol or manual). We hypothesised that alliance and adherence interrelate over the course of the therapy. Method: This study investigated the bidirectional associations between alliance and therapist adherence using cross-lagged panel analyses for a sample of 1970 adolescents and their families participating in Multisystemic Therapy (MST). A number of client characteristics were included as moderators, namely demographic characteristics, type and severity of adolescent problem behaviour, and whether or not the MST treatment was court ordered. Alliance and adherence were scored by the primary caregiver through telephone interviews at monthly intervals during treatment.
Results: Alliance in 1 month predicted therapist adherence in a subsequent month. Adherence only predicted subsequent alliance during the middle part of the treatment process. The results were not moderated by any of the client factors. Conclusions: The results suggest that alliance and therapist adherence may reinforce one another during therapy. Although alliance may facilitate the development of therapist adherence, adherence may subsequently deepen and consolidate the client–therapist alliance. These results are independent of client characteristics.