The role of therapeutic alliance in therapy outcomes for youth in residential care

Michael L. Handwerk, Jonathan C. Huefner, Jay L. Ringle, Brigid K. Howard, Stephen H. Soper, Julie K. Almquist, M. Beth Chmelka

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


This study examined the impact of therapeutic alliance (TA) on therapy outcomes for youth with behavioral and emotional problems residing in residential care. Study participants were 71 youth in an out-of-home family-style residential treatment facility who were referred to an onsite psychotherapy clinic. A therapeutic alliance scale was completed independently after each session by the youth and their therapist. Two outcome measures were used: a symptom scale that was completed by the youth before each therapy session, and a daily observational measure made by direct care staff of all significant events for each youth. Youth symptoms improved significantly over the course of therapy and their behaviors decreased to a rate similar to their peers. TA ratings, however, were only marginally related to therapy outcomes. Implications for assessing therapeutic alliance in child therapy are discussed.

Original languageEnglish (US)
Pages (from-to)145-165
Number of pages21
JournalResidential Treatment for Children and Youth
Issue number2
StatePublished - Sep 4 2008
Externally publishedYes


  • Children & adolescents
  • Therapeutic alliance
  • Therapy
  • Therapy outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Law


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