Developing a therapeutic alliance in the hospital treatment of disturbed adolescents

Establishing a working therapeutic relationship with psychiatrically hospitalized adolescents presents special challenges to the hospital treatment team. Many adolescent patients deny their problems or any responsibility for them, and defy efforts to engage them in active collaboration. However, once the treatment team understands the specific clinical and developmental reasons for their reluctance to participate, most patients can become profitably involved in treatment. The author discusses the concept of the therapeutic alliance, suggesting that many hospitalized disturbed adolescents do not reach this optimal level of involvement. Clinical vignettes illustrate the precursors to and levels of genuine collaboration, as well as interventions that facilitate collaborative behavior.