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

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.