A Therapeutic Alliance with Youth: Building a Client's Trust Can Be a Challenging Process
Dyer, Fred, Addiction Professional
Therapeutic alliance is often referred to as the sine qua non of all successful clinical work. This holds true in working with adolescents with substance abuse problems, whether in inpatient, out-patient or residential settings and regardless of the service delivery mode (individual or group counseling). It is important for the counselor to remember that youths do not volunteer to enter treatment and that they will present with other problem behaviors that interact with their substance use.
An additional salient factor for counselors to consider when working with adolescents is that many of their clients can recount few positive experiences in their lives and might come from negative circumstances that can produce the cognitive schema that adults cannot be trusted and that the world is not a safe place. "I will cope and manage my life on my own terms, because no one cares what I think or feel" could be these individuals' established mantra.
Components of alliance
The therapeutic alliance is a construct referring to a collaborative aspect of the relationship between adolescent counselor and client in the context of clinical intake interviewing, or of inpatient or outpatient substance abuse counseling. Bordin (1) lists the following components:
* An agreement between the counselor and youth about the goals of treatment.
* An agreement about the counseling tasks needed to accomplish those goals.
* An emotional bond between the counselor and adolescent client, which allows the adolescent to make clinical and therapeutic progress.
Research and clinical practice have demonstrated that a therapeutic alliance is a powerful tool for engaging adolescents, (2) and that even substance abuse counselors with limited experience can--with training, supervision and a continuing desire to promote positive change in the lives of their adolescent clients--cultivate an alliance conducive to change. (3)
It is necessary to remember that alliance building is not an event. It is an ongoing process, and little therapeutic benefit will be accomplished in its absence. Dozens of studies have provided evidence of the importance of displaying empathy in developing a therapeutic alliance for achieving positive outcomes. (4)
The following items represent guidelines for counselors for cultivating a therapeutic alliance:
* Like adolescents.
* Understand adolescent development.
* Offer a snack.
* Allow the youth to occupy his/her hands while talking.
* Allow the youth to wear his/her hat, if applicable.
* Be nonjudgmental.
* Don't be a parent.
* Don't be a peer.
* Avoid lecturing.
* Don't trivialize an adolescent's concerns.
* Learn to be quiet and let the adolescent talk.
* Be supportive.
* Do not tell the adolescent what he/ she thinks.
* Look for opportunities to affirm prosocial behaviors and/or responses.
* Be emotionally and physically present.
* Acknowledge the adolescent's narcissism/strengths.
* Chase the affect.
* Maintain an objective stance.
* Promote self-efficacy.
* Offer advice if and when asked.
In proposing the aforementioned guidelines for cultivating a therapeutic alliance, below are components that work against the development of the alliance:
* Excessive writing during the interview or counseling session,
* Not listening.
* Lack of warmth.
* Lack of empathy for the youth's symptoms or circumstances.
* Trivializing the adolescent's concerns.
Studies have shown that youth-counselor relationships are the most consistent predictor of client improvement. …