Goal consensus and task agreement as predictors of attendance and compliance in community-based treatments for adolescents with emotional disorders.

backgroundSeveral psychosocial treatments for adolescents with anxiety and depressive disorders have been shown to be effective. However, when evaluated in community clinics, response rates are poor, in part due to higher attrition and low treatment compliance. The working alliance between clinician and client is one important predictor of therapy attendance and compliance. Working alliance is comprised of three different components (i.e., goal consensus, task agreement, and bond). However, there is little research examining the unique contributions of two key components, goal consensus and task agreement. Exploring these components individually may shed light on important clinician-client interactions during therapy that might reduce attrition and improve compliance. The purpose of this study is to evaluate whether clinician and adolescent perceptions of agreement on (1) therapy goals (referred to as goal consensus) and (2) the tasks or actions needed to reach the goals (referred to as task agreement) predict therapy attendance and compliance in the context of a community-based randomized controlled trial of treatments for adolescents with emotional disorders.

methodsParticipants include 89 clinicians (87.7% White) and 166 adolescents (mean age 14.7; 62.0% White) with a primary anxiety or depressive disorder enrolled in the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET) study. Data on goal consensus and task agreement were collected digitally eight weeks after the initiation of treatment using the Working Alliance Inventory, reported by clinician and adolescent. Treatment compliance was rated by the clinician after each weekly session (1 = poor compliance to 7 = good compliance), and therapy attendance was measured by the total number of therapy sessions attended over 16 weeks.

resultsResults of linear regression models, controlling for baseline anxiety/depression severity, treatment condition, and adolescent demographic characteristics, revealed that higher goal consensus (reported by both adolescent and clinician) significantly predicted higher attendance and compliance. Similarly, adolescent and clinician reports of higher task agreement predicted higher session attendance and treatment compliance.

conclusionThe current findings suggest that the more that adolescents and clinicians agreed on setting goals and the therapeutic tasks to achieve those goals, the more frequently adolescents attended therapy and complied with therapy expectations. Creating structured approaches to confirming goals and agreement on therapy tasks throughout treatment may be important and promote better treatment attendance and compliance and ultimately better outcomes for adolescents with emotional disorders.