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SPs are a common childhood disorder and a predictor of future mental health conditions. While Cognitive Behavioural Therapy (CBT) and One-Session Treatment (OST) are effective in treating SPs, a notable percentage of children do not fully respond. The study examined key therapeutic process variables among a sample of 52 children and their parents who participated in the broader Preschoolers\u2019 Overcoming Phobias randomised controlled trial. Variables included child and parent therapeutic alliances, child motivation, homework adherence, therapist treatment fidelity, parent satisfaction, and parental confidence in implementing exposure and managing their own fears. Results indicated that child therapeutic alliance and parental confidence in managing fears were significant predictors of child outcomes at six months post-treatment. Specifically, parental confidence mediated the relationship between their ability to conduct exposure and the child\u2019s approach behaviour. This suggests that effective SP treatments should focus on both the child\u2019s direct therapy and supporting parents in managing their child\u2019s anxieties.<\/jats:p>","DOI":"10.1007\/s10578-025-01902-7","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T10:16:03Z","timestamp":1755080163000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Therapeutic Processes that Impact Child Outcomes Following Exposure Therapy for Child Specific Phobias"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4019-4367","authenticated-orcid":false,"given":"Imogene G.","family":"Calteaux","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5400-462X","authenticated-orcid":false,"given":"David L.","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4231-2227","authenticated-orcid":false,"given":"Lara J.","family":"Farrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"issue":"1","key":"1902_CR1","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1037\/a0030551","volume":"25","author":"EC Accurso","year":"2013","unstructured":"Accurso EC, Hawley KM, Garland AF (2013) Psychometric properties of the therapeutic alliance scale for caregivers and parents. 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