Academic journal article
By Martin, June; Romas, Michael; Medford, Marsha; Leffert, Nancy; Hatcher, Sherry L.
Adolescence , Vol. 41, No. 161
Client expectations are a predominant indicator of treatment outcome and client satisfaction (Horvath, 2001). Adult and adolescent therapeutic treatments have increasingly focused on the alliance between client and therapist. However, aolescents pose unique challenges for therapists (Blos, 1962; Kazdin & Wassell, 1999; Masterson, 1968). Historically, clinicians and researchers have maintained that adolescents are in a crucial and formative stage of development whereby they may have a "second chance" to resolve earlier conflicts from childhood, prior to consolidating their adult identities (Blos, 1962). Masterson's (1968) classic research suggests that psychological problems appearing in adolescence are unlikely to be "outgrown" and immediate therapeutic intervention may prevent the development of future, if not greater, psychopathology.
A lack of measures of adolescents' preferred adult qualities in helping relationships with adults led to our attempt to derive indicators of therapeutic alliance for use with adolescent clients. Available scales that are currently reported in the literature primarily focus on the therapeutic relationship from the perspective of the therapist. Consequently, knowledge of adolescents' perspectives on the helping relationship is unknown. The focus group study reported here was undertaken to determine helping qualities in adults that may be sought by pre-therapy adolescents.
A comprehensive search of the literature failed to reveal more than a few articles related to qualities sought by adolescents in people from whom they might seek help. Although there have been studies of therapist-client alliance measures for use with adolescents, these have been only from the perspective of the therapist (Barber, Connolly, Crits-Christoph, Gladis, & Siqueland, 2000; Hatcher, 1999; Hatcher & Barends, 1996; Joyce, Ogrodniczuk, Piper, & McCallum, 2003). Numerous studies have measured the impact of the therapeutic alliance on treatment outcomes, but these have primarily evaluated adult populations (e.g., Farber, 2003; Horvath, 2001; Martin, Garske, & Davis, 2000).
Roberts, Lazicki-Puddy, Puddy, and Johnson (2003) reviewed past studies of adolescent therapy outcomes within specific diagnostic categories. Hatcher, Barends, Hansell, and Gutfreund (1995) compared patient and therapist views of the alliance, but again utilizing an adult population. In other words, the therapeutic alliance-process outcome literature has historically been written from the therapist's perspective, not the client's (Bachelor, 1995). However valid this may be, attempts to generalize these findings to adolescent populations present problems (Cobb, 1992; Everall & Paulson, 2002; Foreman, Gibbins, Grienenberger, & Berry, 2000; Liddle & Schwartz, 2002; Oetzel & Scherer, 2003; Paulson, Truscott, & Stuart, 1999; Robbins, Turner, & Alexander, 2003; Weisz & Hawley, 2002).
For example, Oetzel and Scherer (2003) suggest that adolescent development is a key component in engaging adolescents in psychotherapy. Adolescents manifest psychopathology differently from adults, and they differ in their ability to cognitively understand their problems or deal with change strategies. According to Scales and Leffert (1999), youth typically experience a significant decrease in support during middle school and high school and "about three out of every four adolescents say they do not have positive family communication or a caring school" (p. 41). Numerous researchers have noted that the challenges presented by cognitive developmental change and emotional processing during adolescence require separate empirical investigation into adolescent alliance process-outcome studies (Everall & Paulson, 2002; Kazdin, 1991; Kazdin & Weisz, 1998).
Everall and Paulson (2002) identified three themes that are unique to the development of adolescent alliance: "therapeutic environment, uniqueness of the therapeutic relationship, and therapist characteristics" (p. …