Youth and Parent Alliances with Therapists: Effects on Processes and Outcomes of Mental Health Services

Relationships between therapists and the people they treat have often been hypothesized to affect the outcomes of mental health services. To test the possible effects of both youth- and parent-reported alliances with therapists, Hawley and Weisz (2005) had 65 7- to 16-year-olds and their parents separately complete scales assessing positive and negative aspects of alliances with therapists who were seeing the youths in four Los Angeles outpatient clinics.

The youths also completed the YSR and their parents completed the CBCL at intake and again 6 months, 1 year, and 2 years after intake. Information was obtained on retention in therapy in terms of the percentage of sessions attended by family members; the percentage of sessions that were missed or cancelled; and ratings of the level of concurrence about termination. Satisfaction with services was assessed by scales completed separately by youths and their parents.

It was found that retention in therapy was significantly better when parent alliance scores were favorable than when they were unfavorable, but youth alliance scores were not significantly related to therapy retention. On the other hand, favorable youth alliance scores were positively associated with good outcomes of services, as assessed by both the YSR and CBCL. As might be expected, positive associations were also found between favorable alliance scores and ratings of satisfaction with therapy.

The authors concluded “that both parent-therapist and youth-therapist alliances may be important in outpatient youth mental health services” (p. 127). However, parent-therapist alliances may be particularly important for retaining families in therapy, whereas youth-therapist alliances may be particularly important for achieving reductions in problems, as reported by youths on the YSR and parents on the CBCL.

Reference: Hawley, K.M., & Weisz, J.R. (2005). Youth versus parent working alliance in usual clinical care: Distinctive associations with retention, satisfaction, and treatment outcome. Journal of Clinical Child and Adolescent Psychology, 34, 117-128.