What Constitutes a Good Working Alliance in Therapy with Children That May Have Been Sexually Abused?

Abstract

The use of qualitative methods in a case by case study of fifteen psychotherapies with children allowed for inquiries into how the working alliance can be established when children are involved. Therapy hours were recorded, and the children’s, their caregivers’ and the therapists’ views about what happened during therapy were collected at the end of therapy and at one year follow-up. The referral to psychotherapy was a suspicion of sexual abuse. The results show how the working alliance is related to not only the child’s, but also the caregiver’s understanding of the therapeutic process. This includes sharing an understanding of the therapeutic goals and tasks, the emotional bond, and how the caregivers become involved and support their children’s participation in therapy. An expanded understanding of Bordin’s concept of the working alliance along two dimensions is suggested: the first one is from an adult to a child deduced understanding of the therapeutic process that bears in mind the child’s capacity for understanding complex change processes, and the second is from a dyadic to a systemic understanding of the alliance.