Developing the therapeutic alliance in child-adolescent psychotherapy

The psychotherapy process research on the therapeutic alliance in child and adolescent psychotherapy is alarmingly scarce. Findings from the adult therapeutic alliance literature and from the few existing studies on child and adolescent therapeutic alliance are reviewed. Bordin's (1975) model of the working alliance and Prochaska and DiClemente's (1988) stages of change model are employed to evaluate existing strategies for building alliances with child and adolescent clients and to develop proposed strategies. The facts that (a) children are most often not self-referred and (b) frequently come to therapy in a resistant, precontemplative stage of change are presented as the major obstacles to forming effective alliances with children and adolescents. Traditional child and adolescent psychotherapies may fail to develop effective alliances due to their primary focus on the development of the bond and neglect in achieving agreement on the goals and tasks of therapy. Multimodal strategies for building therapeutic alliances with children and adolescents incorporating techniques from emotional script theory, social problem-solving theory, motivational interviewing, and strategic family systems theories are presented.