The alliance in child and adolescent psychotherapy

The therapeutic alliance has a long history in the child and adolescent psychotherapy literature. This article examines prominent views on the alliance with youth and considers a number of issues that distinguish youth alliance from its adult counterpart. A meta-analysis of alliance-outcome associations in individual youth therapy is presented. In order to provide a direct comparison with the adult literature, the review included only prospective studies of individual youth therapy that used an explicit measure of alliance. Results from 16 studies revealed consistency with the adult literature with a weighted mean correlation of .22 (k = 16, n = 1306, p < .001) between alliance and outcome (CI = +/-.06). Although there were trends showing stronger alliance-outcome associations for child versus adolescent therapy and for behavioral versus nonbehavioral therapies, only problem type (substance abuse and mixed problems vs. eating disorders) significantly moderated alliance-outcome associations. Limitations of the research and implications for therapeutic practice are discussed.