The therapeutic relationship in cognitive-behavioral therapy and pharmacotherapy for anxious youth

Colleen M. Cummings, Nicole E. Caporino, Cara A. Settipani, Kendra L. Read, Scott N. Compton, John March, Joel Sherrill, John Piacentini, James McCracken, John T. Walkup, Golda Ginsburg, Anne Marie Albano, Moira Rynn, Boris Birmaher, Dara Sakolsky, Elizabeth Gosch, Courtney Keeton, Philip C. Kendall

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objective: We examined the therapeutic relationship with cognitive-behavioral therapists and with pharmacotherapists for youth from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008). The therapeutic relationship was examined in relation to treatment outcomes. Method: Participants were 488 youth (ages 7-17 years; 50% male) randomized to cognitive-behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), their combination, or placebo pill. Participants met criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). The therapeutic relationship was assessed by youth report at Weeks 6 and 12 of treatment using the Child's Perception of Therapeutic Relationship scale (Kendall et al., 1997). Outcome measures (Pediatric Anxiety Rating Scale; Research Units on Pediatric Psychopharmacology Anxiety Study Group, 2002; and Clinical Global Impressions Scales; Guy, 1976) were completed by independent evaluators blind to condition. Results: For youth who received CBT only, a stronger therapeutic relationship predicted positive treatment outcome. In contrast, the therapeutic relationship did not predict outcome for youth receiving sertraline, combined treatment, or placebo. Conclusion: A therapeutic relationship may be important for anxious youth who receive CBT alone.

Original languageEnglish (US)
Pages (from-to)859-864
Number of pages6
JournalJournal of Consulting and Clinical Psychology
Issue number5
StatePublished - Oct 2013
Externally publishedYes


  • Anxiety
  • CBT
  • pharmacotherapy
  • therapeutic relationship
  • youth

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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