Relationship between the therapeutic alliance, clients' reactions to artistic work and outcomes of arts therapies with ultra-orthodox 4–15 year olds

The therapeutic relationship formed during arts therapies with ultra-orthodox children and teens, when it is provided by therapists who are not ultra-orthodox themselves, may suffer from an intercultural gap. This quantitative longitudinal study examined the therapeutic alliance (TA) and clients' reactions to the artistic work (ABI) in arts therapies with young ultra-orthodox clients, and the relationship of these process variables to changes in self-concept, behavior and functioning in a dedicated educational setting. Forty-one ultra-orthodox clients aged 4–15 (M=6.54, SD=2.33) and 17 arts therapists from diverse religious/cultural backgrounds filled out process questionnaires three times during therapy. The clients, their mothers, and the educational staff provided information on the outcome variables at the beginning and end of therapy. The findings partially confirmed the hypotheses of a positive relationship between TA and ABI, between the two and changes in the outcome variables. The clients’ and therapists’ perspectives on the TA were only positively correlated towards the end of therapy. Positive correlations were found between ABI and TA, but a negative correlation emerged between TA at the beginning of therapy and ABI towards the end of therapy. Positive correlations were found between the process variables and the gain scores; namely, between ABI and improvement in functioning in kindergarten, TA and improvement in cognitive competence of clients treated by secular therapists, and between TA and a decline in hyperactivity/distractibility of clients treated by ultra-orthodox or religious therapists. A negative correlation emerged between TA and increased aggression in clients treated by secular therapists. These findings are discussed in the context of the specificity of this population and intercultural therapy.