Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy

Karver, Marc S.; De Nadai, Alessandro S.; Monahan, Maureen; Shirk, Stephen R.

doi:10.1037/pst0000176

Cited by 234Psychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology ResearchCounseling Practices and Supervision

Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy

Karver, Marc S., De Nadai, Alessandro S., Monahan, Maureen, Shirk, Stephen R.·2018·Psychotherapy

DOI 10.1037/pst0000176

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Abstract

In the youth treatment literature, the alliance has been defined and measured as a consensual or collaborative bond. In this article, we review varied definitions of the alliance, enumerate its frequent measures, and present clinical examples. We provide a meta-analytic review on the relation between the therapeutic alliance and treatment outcome in child and adolescent psychotherapy. In particular, this review only includes prospective studies of youth therapy that used an explicit measure of alliance. The meta-analysis of 28 studies revealed a weighted random effect size of r = .19 (k = 28, N = 2419, p < .01, 95% confidence interval [.13, .25]), which is a small to medium effect (equivalent to d = 0.39) consistent with the adult alliance literature and with prior youth meta-analyses. Given that a medium-large amount of heterogeneity was observed in effect sizes (I2 = 64.19%), theory- and method-based moderators were examined. Multiple moderators of the alliance-outcome association were found, including diagnosis class, type of therapy, study design (randomized controlled trials [RCT] vs. nonrandomized trials [non-RCT]), and treatment setting (inpatient vs. outpatient). Research limitations, patient contributions, and diversity considerations follow. The article concludes with research-informed practices for building and maintaining the therapeutic alliance with youth. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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Alliance is a well-studied mechanism of change that has consistently shown a moderate association with outcomes in face-to-face therapy in both adults and youths.
“Alliance is another well-studied mechanism of change that has consistently shown a moderate association with outcomes in face-to-face therapy in both adults and youths (Flückiger et al., 2018; Karver et al., 2018).”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Karver et al., 2018
The lack of association between alliance and outcome contrasts with the predictive value of a positive alliance in face-to-face treatments but aligns with prior research on alliance in ICBT for adults.
“This contrasts with the predictive value of a positive alliance in face-to-face treatments (Flückiger et al., 2018; Karver et al., 2018), but aligns with prior research on alliance in ICBT for adults.”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Karver et al., 2018
Previous research has found that the TA generally has moderate but reliable correlations with clinical outcomes across all types of mental health problems and treatment approaches in both young people and adults.
“Previous research has found that the TA generally has moderate but reliable correlations with clinical outcomes across all types of mental health problems and treatment approaches in both young people and adults (25–27).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [26]
These mixed findings are inconsistent with findings from face-to-face therapy.
“These mixed findings are inconsistent with findings from face-to-face therapy (25–27).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [26]

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A randomized waitlist-controlled trial of voice over internet protocol-delivered behavior therapy for chronic tic disorders
Ricketts, E. J. (2014) · UWM Digital Commons (University of Wisconsin–Milwaukee) · Cited by 1 · see citing works
The Alliance-Outcome Association in CBT and Usual Care for Youth Depression Delivered in Community Settings
Avny, S. B. (2011) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/2jde-kz86 · Cited by 1 · see citing works
The Relationship Between Therapeutic Alliance and Treatment Outcome in Prolonged Exposure Therapy for Adolescents with Posttraumatic Stress Disorder
Capaldi, S. (2010) · Digital Commons - PCOM (Philadelphia College of Osteopathic Medicine) · Cited by 1 · see citing works
Factors Predicting Therapeutic Alliance in Antisocial Adolescents
Simpson, T. P. (2008) · ScholarWorks @ The University of New Orleans (The University of New Orleans) · Cited by 1 · see citing works

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The alliance in mental health care: conceptualization, evidence and clinical applications
Wampold, B. E., & Flückiger, C. (2023) · World Psychiatry · doi:10.1002/wps.21035 · Cited by 231 · see citing works
Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review
Tong, F., Lederman, R., D'Alfonso, S., Berry, K., & Bucci, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.819623 · Cited by 106 · see citing works
Non-specific versus targeted approaches to youth mentoring: A follow-up meta-analysis
Christensen, K. M., Hagler, M. A., Stams, G.-J., Raposa, E. B., Burton, S., & Rhodes, J. E. (2020) · Journal of Youth and Adolescence · doi:10.1007/s10964-020-01233-x · Cited by 107 · see citing works
Working toward anti-racist perspectives in attachment theory, research, and practice
Stern, J. A., Barbarin, O. A., & Cassidy, J. A. (2021) · Attachment & Human Development · doi:10.1080/14616734.2021.1976933 · Cited by 112 · see citing works
Distinct roles of state-like and trait-like patient–therapist alliance in psychotherapy
Zilcha‐Mano, S., & Fisher, H. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-022-00029-z · Cited by 89 · see citing works
Non-disclosing youth: a cross sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional
McGillivray, L., Rheinberger, D., Wang, J. J., Burnett, A., & Torok, M. H. (2022) · BMC Psychiatry · doi:10.1186/s12888-021-03636-x · Cited by 78 · see citing works
A Multidimensional Examination of the Measurement of Treatment Engagement: Implications for Children’s Mental Health Services and Research
Lakind, D., Bradley, W. J., Patel, A., Chorpita, B. F., & Becker, K. D. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1941057 · Cited by 60 · see citing works
A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy
Roest, J. J., de Poll, M. J. W.-V., van der Helm, P. G., Stams, G. J. J. M., & Hoeve, M. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2022.2093210 · Cited by 60 · see citing works
Future Directions in Youth and Family Treatment Engagement: Finishing the Bridge Between Science and Service
Becker, K. D., & Chorpita, B. F. (2023) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2023.2169926 · Cited by 57 · see citing works
A dual perspective on first-session therapeutic alliance: strong predictor of youth mental health and addiction treatment outcome
van Benthem, P., Spijkerman, R., Blanken, P., Kleinjan, M., Vermeiren, R. R. J. M., & Hendriks, V. M. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01503-w · Cited by 46 · see citing works
Measuring Perceptions of the Therapeutic Alliance in Individual, Family, and Group Therapy from a Systemic Perspective: Structural Validity of the SOFTA‐s
Álvarez, I., Herrero, M., Martínez‐Pampliega, A., & Escudero, V. (2020) · Family Process · doi:10.1111/famp.12565 · Cited by 47 · see citing works
The factor structure of the Working Alliance Inventory short-form in youth psychotherapy: an empirical investigation
Cirasola, A., Midgley, N., Fonagy, P., Impact Consortium, & Martin, P. (2021) · Psychotherapy Research · doi:10.1080/10503307.2020.1765041 · Cited by 42 · see citing works
The Digital Therapeutic Alliance With Mental Health Chatbots: Diary Study and Thematic Analysis
Xu, Z., Lee, Y., Stasiak, K., Warren, J., & Lottridge, D. M. (2025) · JMIR Mental Health · doi:10.2196/76642 · Cited by 50 · see citing works
Conceptualizing the digital therapeutic alliance in the context of fully automated mental health apps: A thematic analysis
Tong, F., Lederman, R., D’Alfonso, S., Berry, K., & Bucci, S. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2851 · Cited by 35 · see citing works
Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation
Tanzilli, A., & Gualco, I. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.42 · Cited by 36 · see citing works
The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence
Hutsebaut, J., Clarke, S. L., & Chanen, A. M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1130417 · Cited by 36 · see citing works
“The therapeutic relationship is one of the most important common factors determining treatment success in young people (66) and treatment might be especially successful when a practitioner succeeds in building a genuine and authentic relationship (67).”
Background
“I’m still here, but no one hears you”: a qualitative study of young women’s experiences of persistent distress post family-based treatment for adolescent anorexia nervosa
Conti, J., Joyce, C., Natoli, S., Skeoch, K., & Hay, P. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00496-4 · Cited by 35 · see citing works
The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists
Núñez, L., Midgley, N., Capella, C., Álamo, N., Mortimer, R., & Krause, M. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.1876946 · Cited by 33 · see citing works
Therapeutic Alliance Formation for Adolescents and Young Adults with Autism: Relation to Treatment Outcomes and Client Characteristics
Brewe, A. M., Mazefsky, C. A., & White, S. W. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04623-z · Cited by 30 · see citing works
A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy
Roest, J. J., de Poll, M. J. W.-V., van der Helm, P., Stams, G. J. J. M., & Hoeve, M. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-022-00986-2 · Cited by 29 · see citing works
Cognitive Behavioral Intervention for Youth at Risk for Conduct Problems: Future Directions
Lochman, J. E., Boxmeyer, C. L., Kassing, F., Powell, N. P., & Stromeyer, S. L. (2019) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2019.1567349 · Cited by 27 · see citing works
The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists
Núñez, L., Fernández, S., Álamo, N., Midgley, N., Capella, C., & Krause, M. (2022) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2022.556 · Cited by 27 · see citing works
Clinician Reactions When Working with Adolescent Patients: The Therapist Response Questionnaire for Adolescents
Tanzilli, A., Gualco, I., Baiocco, R., & Lingiardi, V. (2019) · Journal of Personality Assessment · doi:10.1080/00223891.2019.1674318 · Cited by 25 · see citing works
Are therapist adherence and competence related to clinical outcomes in cognitive-behavioral treatment for youth anxiety?
Southam‐Gerow, M. A., Chapman, J. E., Martinez, R. G., McLeod, B. D., Hogue, A., Weisz, J. R., & Kendall, P. C. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000538 · Cited by 26 · see citing works
Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy.
Halfon, S. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000620 · Cited by 24 · see citing works
Treating children's aggressive behavior problems using cognitive behavior therapy with virtual reality: A multicenter randomized controlled trial
Alsem, S. C., van Dijk, A., Verhulp, E. E., Dekkers, T. J., & de Castro, B. O. (2023) · Child Development · doi:10.1111/cdev.13966 · Cited by 23 · see citing works
Common elements of evidence-based systemic treatments for adolescents with disruptive behaviour problems
van der Pol, T. M., van Domburgh, L., van Widenfelt, B. M., Hurlburt, M. S., Garland, A. F., & Vermeiren, R. R. J. M. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30085-9 · Cited by 23 · see citing works
“I didn’t have to look her in the eyes”—participants’ experiences of the therapeutic relationship in internet-based psychodynamic therapy for adolescent depression
Lindqvist, K., Mechler, J., Midgley, N., Carlbring, P., Carstorp, K., Neikter, H. K., Strid, F., von Below, C., & Philips, B. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2150583 · Cited by 22 · see citing works
Integrating the Voices of Youth with Lived Experience as Co-researchers to Improve Research and Practice Approaches to Childhood Experiences of Intimate Partner Violence
Cullen, O., Jenney, A., Shiels, L., Greer, K., & SCOTT, K. L. (2023) · Journal of Family Violence · doi:10.1007/s10896-023-00558-y · Cited by 22 · see citing works
MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations
Kangaslampi, S., & Zijlmans, J. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02310-9 · Cited by 23 · see citing works
Youths’ Perceived Impact of Invalidation and Validation on Their Mental Health Treatment Journeys
Simpson, K. S. W., Gallagher, A., Ronis, S. T., Miller, D. A. A., & Tilleczek, K. C. (2021) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-021-01177-9 · Cited by 21 · see citing works
Determinants and Outcomes of the Therapeutic Alliance in Treating Justice-Involved Youth: A Systematic Review of Quantitative and Qualitative Research
Papalia, N. L., Dunne, A. L., Maharaj, N., Fortunato, E., Luebbers, S., & Ogloff, J. R. P. (2022) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-022-00407-2 · Cited by 21 · see citing works
Therapeutic Alliance Between Bereaved Parents and Physicians in the PICU
Suttle, M. L., Hall, M. W., Pollack, M. M., Berg, R. A., McQuillen, P. S., Mourani, P. M., Sapru, A., Carcillo, J. A., Startup, E., Holubkov, R., et al. (2020) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000002585 · Cited by 21 · see citing works
Opening the Black Box of Family-Based Treatments: An Artificial Intelligence Framework to Examine Therapeutic Alliance and Therapist Empathy
Cunningham, P. B., Gilmore, J., Naar, S., Preston, S. D., Eubanks, C. F., Hubig, N., McClendon, J. L., Ghosh, S., & Ryan-Pettes, S. R. (2023) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-023-00451-6 · Cited by 21 · see citing works
The Role of Youth Trainee–Trainer Alliance and Involvement in School-Based Prevention: A Moderated-Mediation Model of Student Gatekeeper Suicide Prevention Training
Totura, C. M. W., Labouliere, C. D., Gryglewicz, K., & Karver, M. S. (2018) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-018-0907-5 · Cited by 20 · see citing works
Self-citation
Alliance-Outcome Associations in a Community-Based Social Skills Intervention for Youth With Autism Spectrum Disorder
Kang, E., Gioia, A. N., Pugliese, C. E., Islam, N. Y., Martinez‐Pedraza, F., Girard, R. M., McLeod, B. D., Carter, A. S., & Lerner, M. D. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.04.006 · Cited by 20 · see citing works
Improving treatment outcomes for adolescents with borderline personality disorder through a socioecological approach
Bo, S., Sharp, C., Kongerslev, M., Luyten, P., & Fonagy, P. (2022) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-022-00187-9 · Cited by 19 · see citing works
Change during cognitive and exposure phases of cognitive–behavioral therapy for autistic youth with anxiety disorders.
Guzick, A. G., Schneider, S. C., Kendall, P. C., Wood, J. J., Kerns, C. M., Small, B. J., Park, Y. E., Cepeda, S. L., & Storch, E. A. (2022) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000755 · Cited by 19 · see citing works
Young people's experience of the therapeutic alliance: A systematic review
Dimic, T., Farrell, A., Ahern, E., & Houghton, S. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2885 · Cited by 19 · see citing works
The role of interpersonal coordination dynamics in alliance rupture and repair processes in psychotherapy—A systematic review
Høgenhaug, S. S., Kongerslev, M., & Telléus, G. K. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1291155 · Cited by 19 · see citing works
If you believe that breaking is possible, believe also that fixing is possible: a framework for ruptures and repairs in child psychotherapy
Nof, A., Dolev, T., Leibovich, L., Harel, J., & Zilcha‐Mano, S. (2019) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2019.364 · Cited by 17 · see citing works
Treatment Engagement as a Predictor of Therapy Outcome Following Cognitive Behaviour Therapy for Autistic Children
Albaum, C. S., Sellitto, T., Vashi, N., Bohr, Y. M., & Weiss, J. A. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06083-7 · Cited by 16 · see citing works
Little Girl, Big Feelings: Online Child Psychotherapy during the COVID-19 Pandemic
Udwin, S., Kufferath-Lin, T., Prout, T. A., Hoffman, L., & Rice, T. (2021) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2021.1999158 · Cited by 15 · see citing works
The impact of session-introducing mindfulness and relaxation interventions in individual psychotherapy for children and adolescents: a randomized controlled trial (MARS-CA)
Kalmar, J., Baumann, I., Gruber, E., Vonderlin, E., Bents, H., Neubauer, A., Heidenreich, T., & Mander, J. (2022) · Trials · doi:10.1186/s13063-022-06212-0 · Cited by 15 · see citing works
A Systematic Review of Therapeutic Process Factors in Mental Health Treatment for Autistic Youth
Albaum, C. S., Vashi, N., Bohr, Y. M., & Weiss, J. A. (2022) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-022-00409-0 · Cited by 13 · see citing works
Therapist Alliance-Building Behaviors, Alliance, and Outcomes in Cognitive Behavioral Treatment for Youth Anxiety Disorders
Fjermestad, K. W., Føreland, Ø., Oppedal, S. B., Sørensen, J. S., Vognild, Y. H., Gjestad, R., Öst, L., Bjaastad, J. F., Shirk, S. R., & Wergeland, G. J. (2020) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2019.1683850 · Cited by 14 · see citing works
Self-citation
Clinical practice during the COVID-19 pandemic: a qualitative study among child and adolescent psychiatrists across the world
Sibéoni, J., Manolios, É., Costa-Drolon, E., Meunier, J.-P., Verneuil, L., & Révah‐Levy, A. (2021) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-021-00417-y · Cited by 14 · see citing works
Determining prognostic variables of treatment outcome in obsessive–compulsive disorder: effectiveness and its predictors in routine clinical care
Herzog, P., Osen, B., Stierle, C. M. G., Middendorf, T., Voderholzer, U., Koch, S., Feldmann, M., Rief, W., & Brakemeier, E. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01284-6 · Cited by 13 · see citing works
Therapeutic Alliance: A Comparison Study between Adolescent Patients and Their Therapists
Gergov, V., MARTTUNEN, M. J., Lindberg, N., Lipsanen, J. O., & Lahti, J. M. T. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111238 · Cited by 13 · see citing works
Four perspectives on traumatized youths’ therapeutic alliance: Correspondence and outcome predictions
Ovenstad, K. S., Jensen, T. K., & Ormhaug, S. M. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.2011983 · Cited by 13 · see citing works
Alliance ruptures and resolutions in short-term psychoanalytic psychotherapy for adolescent depression: An empirical case study
Cirasola, A., Martin, P., Fonagy, P., Eubanks, C. F., Muran, J. C., & Midgley, N. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2061314 · Cited by 13 · see citing works
Adherence, Competence, and Alliance as Predictors of Long-term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders
Bjaastad, J. F., Gjestad, R., Fjermestad, K. W., Öst, L., Haugland, B. S. M., Kodal, A., Heiervang, E. R., & Wergeland, G. J. (2023) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-023-01028-1 · Cited by 13 · see citing works
A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study
O’Sullivan, S., McEnery, C., Cagliarini, D., Hinton, J. D. X., Valentine, L., Nicholas, J., Chen, N. A., Castagnini, E., Lester, J., Kanellopoulos, E., et al. (2024) · JMIR Mental Health · doi:10.2196/49217 · Cited by 13 · see citing works
Teenage Boys in Therapy: A Qualitative Study of Male Adolescents’ Experiences of Short-Term Psychoanalytic Psychotherapy
Marotti, J., Thackeray, L. A., & Midgley, N. (2020) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2020.1832836 · Cited by 13 · see citing works
Lost in explanation: internal conflicts in the discourse of ADHD psychoeducation
van Langen, M. J. M., Szőke, R., Rijkelijkhuizen, D. N. J., Durston, S., & van Hulst, B. M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04327-x · Cited by 12 · see citing works
Patients’ and Psychotherapists’ Combined and Separate Evaluations of the Psychotherapeutic Relationship: The Structure of Working Alliance and Polish Versions of the WAI
Prusiński, T. (2021) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-021-09500-z · Cited by 12 · see citing works
Acceptability, safety and tolerability of antidepressant repetitive transcranial magnetic stimulation for adolescents: A mixed-methods investigation
Wallman, E. J., Segrave, R. A., Gordon, M. S., Fraser, M. J. O. B., Pavlou, C., & Melvin, G. A. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.057 · Cited by 12 · see citing works
Measuring therapeutic alliance in children with autism during cognitive behavior therapy
Riosa, P. B., Khan, M. R., & Weiss, J. A. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2404 · Cited by 12 · see citing works
How Do Mental Health Providers Assess Treatment Engagement of Youth and Caregivers?
Becker, K. D., Wu, E. G., Hukill, A. H., Brandt, N. E., & Chorpita, B. F. (2021) · Journal of Child and Family Studies · doi:10.1007/s10826-021-02042-x · Cited by 12 · see citing works
A Review of Therapeutic Alliance and Child CBT
Feindler, E. L., & Smerling, C. (2022) · Child & Family Behavior Therapy · doi:10.1080/07317107.2022.2027191 · Cited by 12 · see citing works
Therapeutic alliance in the treatment of adolescent substance misuse: a systematic review
Sulaman, I., Hartley, S., & Elvins, R. (2023) · Child and Adolescent Mental Health · doi:10.1111/camh.12671 · Cited by 14 · see citing works
Psychotherapy works – An inclusive and affirming view to a modern mental health treatment
Flückiger, C., Willutzki, U., Holtforth, M. G., & Wampold, B. E. (2024) · Clinical Psychology in Europe · doi:10.32872/cpe.11971 · Cited by 12 · see citing works
Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial
Nissling, L., Weineland, S., Vernmark, K., Radvogin, E., Engström, A.-K., Schmidt, S., Nieto Granberg, E., Larsson, E., & Hursti, T. (2023) · Research in Psychotherapy: Psychopathology, Process and Outcome · doi:10.4081/ripppo.2023.681 · Cited by 10 · see citing works
A retrospective study exploring parents’ perceptions of their child’s assessment
Aschieri, F., Cera, G., Fiorelli, E., & Brasili, S. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1271746 · Cited by 10 · see citing works
The relationship between youth involvement, alliance and outcome in trauma-focused cognitive behavioral therapy
Ovenstad, K. S., Ormhaug, S. M., & Jensen, T. K. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2123719 · Cited by 10 · see citing works
A systematic review and meta-analysis of clinician behaviors and characteristics related to alliance building with youth clients
Orlowski, E. W., Bender, A. M., & Karver, M. S. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102273 · Cited by 10 · see citing works
Self-citation
Are changes in children's communication patterns predictive of treatment outcomes for children with anxiety?
Lichtwarck‐Aschoff, A., & van Rooij, M. M. J. W. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2383 · Cited by 10 · see citing works
Is implementation of ASAM-based addiction treatment assessments associated with improved 30-day retention and substance use?
Mark, T. L., Hinde, J. M., Barnosky, A., Joshi, V., Padwa, H., & Treiman, K. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108868 · Cited by 10 · see citing works
Alliance Between Therapist and Multi-stressed Families During the COVID-19 Pandemic: The Effect of Family-Based Videoconferencing
Lange, A. M. C., Delsing, M. J. M. H., van Geffen, M., & Scholte, R. H. J. (2021) · Child & Youth Care Forum · doi:10.1007/s10566-021-09644-y · Cited by 10 · see citing works
Intervention format and therapist–child agreement associated with therapeutic alliance and outcomes.
Lochman, J. E., Laird, R. D., McDaniel, H. L., Boxmeyer, C. L., Braun, S. S., Powell, N. P., & Lixin Qu, A. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000841 · Cited by 9 · see citing works
Development of a digital therapeutic alliance scale (MM-DTA) in the context of fully automated mental health apps
Tong, F., Lederman, R., D’Alfonso, S., Berry, K., & Bucci, S. (2025) · Behaviour and Information Technology · doi:10.1080/0144929x.2025.2469672 · Cited by 9 · see citing works
Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior
van Herwaarden, A., Schuiringa, H. D., van Nieuwenhuijzen, M., de Castro, B. O., Lochman, J. E., & Matthys, W. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104296 · Cited by 9 · see citing works
Alliance
Flückiger, C. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.02.013 · Cited by 9 · see citing works
Caring Transitions – A Care Coordination Intervention to Reduce Suicide Risk Among Youth Discharged From Inpatient Psychiatric Hospitalization
Gryglewicz, K., Peterson, A. L., Nam, E., Vance, M. M., Borntrager, L. J., & Karver, M. S. (2021) · Crisis · doi:10.1027/0227-5910/a000795 · Cited by 10 · see citing works
Self-citation
The working alliance inventory – short version: psychometric properties of the patient and therapist form in youth mental health and addiction care
van Benthem, P., van der Lans, R. M., Lamers, A., Blanken, P., Spijkerman, R., Vermeiren, R. R. J. M., & Hendriks, V. M. (2024) · BMC Psychology · doi:10.1186/s40359-024-01754-1 · Cited by 8 · see citing works
“I'm not here to push you:” raising adolescents' treatment engagement via autonomy support
van Dijk, A., Brummelman, E., & de Castro, B. O. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104304 · Cited by 11 · see citing works
A Meta-Analysis of Common Factors in Child Therapy Interventions
Warwick, L., Lenz, A. S., Branch, M. L., & Lemberger‐Truelove, M. E. (2023) · Journal of Child and Adolescent Counseling · doi:10.1080/23727810.2023.2215157 · Cited by 8 · see citing works
Group cohesion and alliance predict cognitive-behavioral group treatment outcomes for youth with anxiety disorders
Fjermestad, K. W., Wallin, M. H., Naujokat, F., McLeod, B. D., Silverman, W. K., Öst, L., Lerner, M. D., Heiervang, E. R., & Wergeland, G. J. (2024) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2024.2385906 · Cited by 7 · see citing works
Symptom trajectories of early responders and remitters among youth with OCD
Rech, M., Weinzimmer, S. A., GELLER, D. A., Mcguire, J. F., Schneider, S. C., Patyk, K. C., Nadai, A. S. D., Cepeda, S. C., Small, B. J., Murphy, T. K., et al. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100580 · Cited by 7 · see citing works
Clinical Change Mechanisms in the Treatment of College Students With ADHD: Trajectories and Associations With Outcomes
Langberg, J. M., Dvorsky, M. R., Silvia, P. J., Labban, J. D., & Anastopoulos, A. D. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.11.003 · Cited by 7 · see citing works
Youth Mentoring as a Means of Supporting Mental Health for Minoritized Youth: A Reflection on Three Theoretical Frameworks 20 Years Later
Gowdy, G., Jones, K. V., & Griffith, A. N. (2024) · Youth · doi:10.3390/youth4030076 · Cited by 6 · see citing works
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Alliance in Child and Adolescent Psychotherapy
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Self-citation
The alliance in child and adolescent psychotherapy.
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Self-citation
Relation of the alliance with outcomes in youth psychotherapy: a meta-analysis
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A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy
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The Alliance: From Theory to Practice
Lasky, H. L., Taylor, L. K., & Weist, M. D. (2012)

Authors: Karver, M. S., De Nadai, A. S., Monahan, M., & Shirk, S. R.
Affiliations: University of South Florida (US)
University of Denver (US)
ORCID: Karver, Marc S.
Monahan, Maureen
Venue: Psychotherapy
Publisher: American Psychological Association (APA)
Published: 2018-12
Volume: 55
Issue: 4
Pages: 341-355
ISSN: 0033-3204 (ISSN-L)
1939-1536
DOI: 10.1037/pst0000176
OpenAlex: W2898018055
Cited by: 234
References: 92
Citations by year: 2026: 37 · 2025: 32 · 2024: 36 · 2023: 36 · 2022: 38 · 2021: 24 · 2020: 23 · 2019: 6 · 2018: 2
FWCI: 2.32
Type: journal article
Language: en
Open access: closed
Locations: Psychotherapy (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
Keywords: therapeutic relationship, child and adolescent psychotherapy, treatment outcomes, randomized controlled trials, inpatient vs outpatient treatment
MeSH terms: Therapeutic Alliance, Adolescent, Mental Disorders, Child, Cooperative Behavior, Humans, Prospective Studies, Psychotherapy, Treatment Outcome

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Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy

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