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

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.