Youth versus parent working alliance in usual clinical care: distinctive associations with retention, satisfaction, and treatment outcome.

We investigated associations between both youth-therapist and parent-therapist alliances and retention, satisfaction, and symptom improvement among 65 youth and their parents receiving usual community-based outpatient mental health services. Parent (but not youth) alliance was significantly related to more frequent family participation, less frequent cancellations and no-shows, and greater therapist concurrence with termination decision. In contrast, youth (but not parent) alliance was significantly related to both youth and parent reports of symptom improvement. Youth and parent alliance were each significantly related to their satisfaction with services. Findings suggest that youth and parent alliance may play important but distinctive roles in the processes and outcomes of usual clinical care.