In short, each person's alliance matters, and alliances are not interchangeable. Each and every alliance exerts both direct and interactive effects on the course of treatment. Thus, clinicians should build and maintain strong alliances with each party and be aware of the ways in which, depending on the family's dynamics, the whole alliance is more than the sum of its parts.
The current meta-analysis of prospective studies of individual youth alliance-outcome associations yielded an effect that is quite comparable to results obtained in the adult literature (Martin et al., 2000). It is noteworthy that this is the first meta-analysis to use inclusion criteria that are highly similar to those used in adult meta-analyses. Specifically, the sample was restricted to studies of individual therapy that measured alliance prior to outcome. Although the establishment of temporal ordering is essential for causal inference, it is not sufficient. Nevertheless, these results strengthen the claim that the alliance is an important predictor of treatment outcome in child and adolescent therapy. Future studies need to account for the potential impact of treatment gains prior to alliance measurement, and for other process variables that could share predictive variance with the alliance.
In a meta-analysis of treatments for depression in children, Weisz, McCarty, and Valeri (2006) found that, although various treatments were more effective than no treatment (but with smaller effects than the adult literature), no difference in outcome was found between cognitive and noncognitive approaches. Importantly, none of the approaches currently listed by the American Academy of Child and Adolescent Psychiatry (1997, 1998) Task Force on the Promotion and Dissemination of Psychological Procedures (1995) have been shown to be demonstrably superior to other treatments intended to be therapeutic for the disorder treated.
Analyses of the adult literature limited to direct comparisons of bona fide treatments have provided strong support for the equivalence of outcome, what has long been referred to as the ‘‘dodo bird verdict’’
Furthermore, controlling for allegiance of the researcher to the treatment approach under investigation removed all variability among the effects. In other words, allegiance explained all the observed systematic differences among treatments.
Interestingly, this result is consistent with the finding that evidence-based treatments for youth are superior to usual care only if the evidence-based treatment was developed by the researcher
Given the significant effect that researcher allegiance was shown to have on outcome in this and other studies, considerable care will need to be exercised to ensure evenly balanced allegiance between the treatments being compared.
In light of these and other findings cited, current attempts aimed at identifying and codifying a list of best practices for the treatment of children and adolescents can at best be viewed as premature and at worst misleading. At a minimum, much more research comparing two or more bona fide treatments needs to be done before professional organizations, payers, and regulators deem specific approaches as ‘‘best.’’