The therapeutic alliance in child and adolescent psychotherapy and residential youth care

The alliance is among the most researched subjects in the psychological literature on therapy in both adults and children. Evidently, therapy with children and adolescents is different from adult therapy, because of the involvement of parents or other caregivers. Also, treatment of youth with complex psychosocial and behavioral problems sometimes takes place in a residential setting, in which youth have to form an alliance with multiple professional caregivers. The purpose of the present dissertation was to contribute to the alliance literature in child and adolescent psychotherapy by conducting a series of meta-analyses in order to a) examine the differences and associations between alliance ratings of different informants and b) gain a better understanding of the alliance-outcome association. Further, this dissertation comprises two empirical studies on the alliance in residential youth care. An alliance measure was developed for use in children and young adolescents receiving residential care. A second study focused on the longitudinal relation between alliance and treatment motivation in youth in residential care. The final study of this dissertation is an essay on factors that are assumed to affect the establishment and fostering of an alliance with youth and parents in residential care, and which may also contribute to knowledge on alliance ruptures and the alliance rupture resolution process. Overall, this dissertation adds to the existing knowledge on the alliance in child and adolescent psychotherapy and may contribute to a better understanding of the alliance in residential youth care, in which the alliance should be conceptualized from a systemic perspective.