Alliance, technology, and outcome in the treatment of anxious youth

A strong therapeutic alliance is intuitively important in a cognitive-behavioral treatment Of anxious youth where the child must confront feared stimuli in numerous exposure tasks. Research examining alliance-outcome relationships and the specific role of the alliance is currently limited. Is the alliance supportive in nature, does it enhance client motivation, or is it an active mediator through which change occurs? Technology-based treatment aids and modalities (e.g., interactive CDs, virtual reality exposure, and single-session treatment) offer the potential benefit of promoting active child engagement, an essential goal of CBT, but they also challenge traditional notions of the therapeutic relationship. Conceptual definitions and methodological considerations for assessing the alliance in child anxiety treatment are discussed. A review of technology outcome, and its effect on process follows, concluding with a recommendation that further alliance research is necessary and that advanced technologies provide an opportunity to understand the treatment process further.