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Working Alliance in Adolescent Outpatient Therapy: Youth, Parent and Therapist Reports and Associations with Therapy Outcomes

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Abstract

The perceived quality of the working alliance in psychotherapy has been a consistent predictor of engagement and outcome in adult psychotherapy, yet there is limited research on working alliance in youth psychotherapy, particularly in the context of “usual” community-based services. In this study, we examined working alliance among 78 adolescents referred for community-based psychotherapy, their parents and therapists. We investigated (1) temporal stability of alliance from 1 to 6 months into treatment, (2) consistency among adolescent, parent, and therapist reports of alliances, and (3) associations between alliance and four outcome domains: symptoms, functioning, satisfaction, and environmental impact. We found individual reports of alliance relatively stable from 1 to 6 months into treatment, but consistency among reporters on quality of their alliance was low. We also found adolescent and parent reported alliances with therapists to be positively associated with several outcome indicators.

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Notes

  1. Although these participants may be unique in some way from those who had not begun therapy at the time of the baseline interview, they did not differ from the larger sample on age, gender, race/ethnicity, or initial problem severity.

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Acknowledgements

Preparation of this article was supported by NIMH Grants K01MH01544 and R01MH66070 (to AFG) and the San Diego State University Oscar Kaplan Postdoctoral Fellowship (to KMH). The study described here was approved by the Human Subjects Protection committees at the University of California, San Diego, Children’s Hospital of San Diego, and San Diego State University. We are grateful to Deb Dupuis, Erin Fuda, Elaine Gabayan, Bill Ganger, Caroline Lewczyk, and Sam Seljan for the important roles they played in this project. We would also like to thank the participating clinics, clinicians, and families, without whom this research would not have been possible.

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Authors and Affiliations

  1. Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA

    Kristin M. Hawley

  2. Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego, CA, USA

    Ann F. Garland

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  1. Kristin M. Hawley
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  2. Ann F. Garland
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Correspondence to Kristin M. Hawley.

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Hawley, K.M., Garland, A.F. Working Alliance in Adolescent Outpatient Therapy: Youth, Parent and Therapist Reports and Associations with Therapy Outcomes. Child Youth Care Forum 37, 59–74 (2008). https://doi.org/10.1007/s10566-008-9050-x

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  • DOI: https://doi.org/10.1007/s10566-008-9050-x

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