Aim 12

This project involved the audiotaping of therapy sessions with depressed and suicidal adolescents on a previously funded grant. Each adolescent received 12 sessions of cognitive behavioral therapy, and tapes of these sessions have continued to be coded for aspects of the therapeutic alliance. Previous lab members developed a coding method, the Alliance Observation Rating System, that research assistants and other lab members are trained in to code segments of therapy sessions for predictors of the therapeutic alliance and outcome variables.

This study's principal goal is to develop an observational measure of adolescent therapeutic alliance and treatment participation to evaluate how these factors relate to participation, continuation, and treatment outcomes. Currently, most of the therapeutic alliance literature has focused on adults, and the principles of adolescent alliance were taken from adult findings. This study identifies the need for a measure of adolescent and child alliance that considers developmental changes unique to younger individuals.

Orlowski, E.W., Chen, J. I., Breznik, L. H., Gleason, L. L., & Karver, M. S. (2024). Psychotherapist perceptions of engagement building behaviors with youth clients across developmental levels. Clinical Psychology & Psychotherapy, 31(1).

Orlowski, E.W., Bender, A. M., & Karver, M.S. (2023). A Systematic Review and Meta-Analysis of Clinician Behaviors and Characteristics Related to Alliance Building with Youth Clients. Clinical Psychology Review, 102, 1-16.

Karver, M. S., De Nadai, A. S., Monahan, M., & Shirk, S. R. (2018). Psychotherapy, 55(4), 341-355. Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy.

De Nadai, A. S., Karver, M. S., Murphy, T. K., Cavitt, M. A., Alvaro, J. L., Bengtson, M., Stock, S., Rakhshani, A. C., & Storch, E. A. (2017). Common factors in pediatric psychiatry: A review of essential and adjunctive mechanisms of treatment outcome. Journal of Child and Adolescent Psychopharmacology, 27(1), 10-18. 

Labouliere, C. D., Reyes, J. P., Shirk, S., & Karver, M. (2017). Therapeutic alliance with depressed adolescents: Predictor or outcome? Disentangling temporal confounds to understand early improvement. Journal of Clinical Child and Adolescent Psychology, 46(4), 600-610. 

Polk, S., Horwitz, R., Longway, S., Bonilla, A., Fothergill, K., Karver, M. S., Salmon, P., & Wissow, L. (2017). Surveillance or engagement: Children’s conflicts during health maintenance visits. Academic Pediatrics, 17, 739-746.

Totura, C. M. Wienke, Fields, S. A., & Karver, M. S. (2017). The Role of the Therapeutic Relationship in Psychopharmacological Treatment Outcomes: A Meta‐analytic Review. Psychiatric Services, 69(1), 41-47. 

Bickman, L., Vides de Andrade, A. R., Athay, M. M., Chen, J. I., De Nadai, A. S., JordanArthur, B., & Karver, M. S. (2012). The relationship between change in therapeutic alliance ratings and improvement in youth symptom severity: Whose ratings matter the most? Administration and Policy in Mental Health and Mental Health Services Research, 39(1), 78-89. 

Jordan-Arthur, B., Romero, G., & Karver, M. S. (2011). The importance of therapeutic alliance for transition-aged youth. Focal Point, 25(Summer), 8-10.

Shirk, S. R., Karver, M. S., & Brown, R. (2011). The alliance in child and adolescent psychotherapy. Psychotherapy, 48(1), 17-24. 

Karver, M. S. & Caporino, N. (2010). The use of empirically-supported strategies for building a therapeutic relationship with an adolescent with oppositional defiant disorder. Cognitive and Behavioral Practice, 17(2), 222-232. 

Karver, M. S., Shirk, S., Handelsman, J., Fields, S., Crisp, H., Gudmundsen, G., & McMakin, D. (2008). Relationship processes in youth psychotherapy: Measuring alliance, alliance building behaviors, and client involvement. Journal of Emotional and Behavioral Disorders. 16(1), 15-28. 

Totura, C. M. Wienke, Aguirre, S., Karver, M. S., & Caporino, N. (2008). Engaging adolescents in the therapeutic process. Independent Practitioner. 28(4), 203-205. 

Karver, M. S., Handelsman, J., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationships variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26, 50-65. 

Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2005). A theoretical model of common process factors in youth and family therapy. Mental Health Services Research, 7(1), 35-52.

Shirk, S., & Karver, M. S. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71(3), 452-464. 

Bickman, L., Rosof-Williams, J., Salzer, M. S., Summerfelt, W. T., Noser, K., Wilson, S. J., & Karver, M. S. (2000). What information do clinicians value for monitoring adolescent client progress and outcomes? Professional Psychology, 31(1), 70-74.

Karver, M. S., Le, K., Webster, A., Schuck, A., & Cao, E. (2024, January). Suicide Prevention: Where we have been and new directions. Keynote Speaker Presentation to the 6th annual meeting of the virtual Activist Lab Boot Camp.

Bohn, J., Karver, M., Roggenbaum, S., Sever, A., & Agrawal, K. (2024, January). Suicide Prevention Panel. Panel discussion member at the 6th annual meeting of the virtual Activist Lab Boot Camp.

Karver, M. S., Lamb, K., & Ellingsen, K. (2023, October). Speaker. Speaker on CBT with Children which was part of a panel at the Clinical Psychology Area Meeting, University of South Florida, Tampa, FL.

Orlowski, E. W., Bender, A., & Karver, M.S. (2020, June). What Do We Actually Know About Alliance Building with Youth Clients?: A Systematic Review and Meta-Analysis of Therapist Behaviors Related to Alliance Building with Youth Clients. Paper accepted (presented in book of abstracts) at cancelled 51st annual meeting of the Society for Psychotherapy Research, Amherst, MA.

Orlowski, E. W., Bender, A., Salach, J., Gryglewicz, K., & Karver, M.S. (2020, April). It’s Not Just What You Do, It’s How You Do It: An Evaluation of the Role of Trainer Alliance and Cultural Competence in Role Play Suicide Risk Assessment Trainings. Paper virtually presented to the 53rd annual meeting of the American Association of Suicidology, Portland, OR.

Karver, M.S. (2019, December). Suicide Prevention: Research and Recommendations for Working with At-risk Youth. Invited paper presented for the annual David Gallagher Memorial Lecture at the NYU Child and Adolescent Psychiatry Grand Rounds, New York, NY.

Orlowski, E. W., Salach, J., Bender, A., Waymire, S., & Karver, M.S. (2019, April). Building the Relationship: The Role of Therapeutic Alliance in the Reduction of Suicidal Ideation in Depressed Adolescents. Paper presented to the 52nd annual meeting of the American Association of Suicidology, Denver, CO.

Courteaux, M., Monahan, M., DeNadai, A., Orlowski, E., Rosler, M., Hangartner, R., Williams, L., Peterson, A., Shirk, S. & Karver, M. (2017, November). Therapeutic alliance in CBT for youth: An updated meta-analysis. Poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Jones, A. E., De Nadai, A. S., Stock, S., Bengston, M., Cavitt, M., Murphy, T. K., Alvaro, J., Storch, E. A., & Karver, M. S. (2014, November). Therapeutic alliance as a predictor of medication adherence in pediatric psychiatry. Poster presented at the 47th annual meeting of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.

Nagpal, P., De Nadai, A. S., Cavitt, M., Alvaro, J., Stock, S., Bengston, M., Murphy, T. K., Karver, M. S., & Storch, E. A. (2014, November). Motivation for change and outcome expectancies as predictors of adherence in pediatric psychiatric practice. Poster presented at the 47th annual meeting of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.

Nagpal, P., De Nadai, A. S., Murphy, T. K., Alvaro, J., Cavitt, M., Stock, S., Bengston, M., Karver, M. S., & Storch, E. A. (2014, November). Utilizing informant discrepancies in child assessment to predict pediatric therapeutic processes. Poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.

De Nadai, A. S., Karver, M. S., Murphy, T. K., Cavitt, M., Alvaro, J., Bengston, M., Stock, S., & Storch, E. A. (2014, October). Therapeutic alliance predicts medication adherence in pediatric psychiatric practice. Poster presented at the annual All Children’s Hospital-Johns Hopkins Medicine Research Symposium, St. Petersburg, FL.

Brown, R., Jordan-Arthur, B., Steding, L., Chen, J., Bickman, L., & Karver, M. S. (2014, March). The role of youth motivation and alliance in youth treatment outcome. Poster presented at 2014 ResearchOne Graduate Student Research Symposium, Tampa, FL.

Steding, L., Jordan-Arthur, B., Brown, R., Chen, J., Bickman, L., & Karver, M. S. (2014, March). Trajectories of motivation and alliance in psychotherapy with youth. Poster presented at 2014 ResearchOne Graduate Student Research Symposium, Tampa, FL.

Brown, R., Jordan-Arthur, B., Steding, L., Chen, J., Bickman, L., & Karver, M. S. (2013, November). The role of youth motivation and alliance in youth treatment outcome. Poster presented at the 47th meeting of the Association for Behavioral and Cognitive Therapies, Nashville, TN.

Gleason, L., DeNadai, A., Roeper, C., Bengtson, M., Alvaro, J. L., Stock, S. L., Cavitt, M. A., Murphy, T. K., Karver, M. S., & Storch, E. A. (2013, November). Evaluating clinician factors that contribute to therapeutic alliance in pediatric treatment. Poster presented at the 47th meeting of the Association for Behavioral and Cognitive Therapies, Nashville, TN.

Partlow, N., DeNadai, A., Romero, G., Stock, S. L., Murphy, T. K., Cavitt, M. A., Bengtson, M., Alvaro, J. L., Storch, E. A., & Karver, M. S. (2013, November). Modeling the respective roles of motivation, expectancies, and therapeutic alliance in pediatric treatment. Poster presented at the 47th meeting of the Association for Behavioral and Cognitive Therapies, Nashville, TN.

Steding, L., Chen, J., Brown, R., Jordan-Arthur, B., Bickman, L., & Karver, M. S. (2013, November). Trajectories of motivation and alliance in psychotherapy with youth. Poster presented at the 47th meeting of the Association for Behavioral and Cognitive Therapies, Nashville, TN.

Roeper, C., DeNadai, A., Gleason, L., Cavitt, M. A., Bengtson, M., Alvaro, J. L., Stock, S. L., Murphy, T. K., Storch, E. A., & Karver, M. S. (2013, November). Assessment in child clinical psychology: A quantitative consideration of sources of agreement and disagreement in multi-informant measurements. Poster presented at the 47th meeting of the Association for Behavioral and Cognitive Therapies, Nashville, TN.

King, M. A., De Nadai, A. S., Murphy, T. K., Stock, S., Bengtson, M., Cavitt, M., Alvaro, J., Karver, M. S., & Storch, E. A. (2013, February). Relationship factors in psychiatric care. Poster presented at the 23rd annual USF Health Research Day, Tampa, FL.

Jordan-Arthur, B., Chen, J. I., De Nadai, A., Bickman, L., & Karver, M. S. (2012, November). Does the relationship between youth behavioral symptom change and therapeutic alliance differ by gender? In M. S. Karver (Chair), Antecedent variables and mechanisms of behavior change in youth psychotherapy. Symposium paper presented at the 46th meeting of the Association for Behavioral and Cognitive Therapies, Baltimore, MD.

Karver, M. S. (2012, November). Chair. Chair for symposium entitled Antecedent variables and mechanisms of behavior change in youth psychotherapy. Symposium paper presented at the 46th meeting of the Association for Behavioral and Cognitive Therapies, Baltimore, MD.

Karver, M. S. (2012, October). Discussant. Discussant for a keynote address entitled Common factors. Paper presented at the Center for Mental Health Services in Pediatric Primary Care, Baltimore, MD.

Chen, J. I.,, De Nadai, A. S., Labouliere, C., Jordan-Arthur, B., Bickman, L., & Karver, M. S. (2011, November). Chasing alliance: Trajectories of therapeutic alliance and their relationship to outcomes. In M. Karver (Chair), Longitudinal explorations of the therapeutic alliance and other treatment processes in youth psychotherapy. Symposium paper presented at the 45th meeting of the Association for Behavioral and Cognitive Therapies, Toronto, Canada.

Karver, M. S. (2011, November). Chair. Chair for symposium entitled Longitudinal explorations of the therapeutic alliance and other treatment processes in youth psychotherapy. Symposium paper presented at the 45th meeting of the Association for Behavioral and Cognitive Therapies, Toronto, Canada.

Karver, M. S. (2011, October). Discussant. Discussant for a keynote address entitled The principal research core: Trials to test common factors and common elements. Paper presented at the Center for Mental Health Services in Pediatric Primary Care, Baltimore, MD.

Karver, M. S., Brown, R., Gryglywicz, K., Witmeier, M., Elzy, M., Dean, M., Labouliere, C., Jordan-Arthur, B., Chen, J., & Kutash, K. (2011, October). Florida's Suicide Prevention Plan: Does it work?. Invited workshop presented at the 2011 Florida Prevention Conference, Orlando, FL.

De Nadai, A. S., Storch, E. A., & Karver, M. S. (2011, April). Alliance and mechanisms of medication adherence in pediatric psychiatric practice. Paper presented at the annual meeting of the University of South Florida Health Fellows’ Forum.

Karver, M. S. (2010, September). Discussant. Discussant for a keynote address entitled The principal research core: Trials to test common factors and common elements. Paper presented at the Center for Mental Health Services in Pediatric Primary Care, Baltimore, MD.

Reyes, J. P.M., Shirk, S. R., Labouliere, C., & Karver, M. S. (2010, August). Adolescent alliance: Predictor or outcome? Poster presented at the American Psychological Association Conference, San Diego, CA.

Karver, M. S., & Brown, R. (2010, March). The therapeutic alliance in youth psychotherapy: What do we know and what more can we learn? Invited paper presented at Hacettepe University, Ankara, Turkey.

Tarquini, S. J., Labouliere, C. D., Totura, C. M. Wienke, Kutash, K., & Karver, M. S. (2007, December). A SAMHSA initiative: The evaluation of a multiple component suicide prevention program. Poster presented at the SAMHSA/CMHS Youth Suicide Prevention Conference, Portland, OR.

Tarquini, S. J., Labouliere, C. D., Totura, C. M. Wienke, Kutash, K., & Karver, M. S. (2007, November). A SAMHSA initiative: The evaluation of a multiple component suicide prevention program. Poster presented at the Governor’s Office of Drug Control and the Statewide Office of Suicide Prevention’s 2007 Florida Suicide Prevention Conference, Tampa, FL.

Handelsman, J., Reay, W., & Karver, M. S. (2006, October). The relationship between three therapist variables and the therapeutic alliance in youth treatment. Poster presented at the 2006 Kansas Conference in Clinical Child and Adolescent Psychology, Lawrence, KS.

Riley, M., & Karver, M. S. (2006, October). Therapist empathy and its relationship to the formation of the therapeutic alliance with youth clients. Poster presented at the 2006 Kansas Conference in Clinical Child and Adolescent Psychology, Lawrence, KS.

Karver, M. S., Fields, S., Totura, C. M. Wienke, & Tarquini, S. (2005, February). The therapeutic relationship: What do we know and what more can we learn?. Paper presented at University of South Florida Psychiatry Grand Rounds Series (CME credits), Tampa, FL.

Karver, M. S., Handelsman, J., Fields, S., & Bickman, L. (2004, October). Common process factors in child psychotherapy: What’s the evidence for relationship variables? Poster presented at the 2004 Kansas Conference in Clinical Child and Adolescent Psychology, Lawrence, KS.

Fields, S., Handelsman, J., Karver, M. S., & Bickman, L. (2004, March). Parental and child factors that affect the therapeutic alliance. Paper presented at the 17th annual meeting of the Florida Mental Health Institute’s System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL.

Karver, M. S., Fields, S., Day, R., & Handelsman, J. (2003, November). The alliance observation coding system. Poster presented at the 37th meeting of the Association for Advancement of Behavior Therapy, Boston, MA.

Shirk, S., Karver, M. S., & Spirito, A. (2003, November). Relationship processes in youth CBT: Measuring alliance and collaboration. In B. Chu (Chair), Psychotherapy process, adherence, and outcome in the treatment of youth. Symposium conducted at the 37th meeting of the Association for Advancement of Behavior Therapy, Boston, MA.

Karver, M. S., & Shirk, S. (2001, April). Therapeutic alliance: Is it related to outcome in child and adolescent psychotherapy?. Paper Presented at the University of Denver, Denver, CO.

Sapyta, J., Karver, M. S., Bickman, L., & Mason, M. (1999, February). Therapeutic alliance: Importance in settings besides psychotherapy. Paper presented at the 12th annual meeting of the Florida Mental Health Institute’s A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL.