Reliability, factor structure, and validity of an observer-rated alliance scale with youth.

Bryce D. McLeod, Jennifer Cecilione, Amanda Jensen-Doss, Michael A. Southam-Gerow, Philip C. Kendall

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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 (Mage = 10.36 years, SD = 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 (N = 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 (SD = .10) and a mean coder stability of .64 (SD = .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) Public Significance Statement—The alliance, defined as the quality of the relationship between youth and therapist, is thought to be an important part of successful youth treatment. The study found that observers can be trained to rate the youth-therapist alliance in youth treatment and that their ratings are comparable to other ways of assessing alliance. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Original languageEnglish (US)
JournalPsychological Assessment
StateAccepted/In press - 2021


  • alliance
  • factor structure
  • reliability
  • validity

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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