Alliance formation and treatment outcome among maltreated adolescents.

This study examined relationships among maltreatment experience, therapeutic alliance formation, and treatment outcome in a sample of 38 psychiatrically hospitalized adolescents. It was hypothesized that the experience of maltreatment would interfere with alliance formation, thereby compromising the effectiveness of therapy. Results indicated that maltreatment, multiplicity of maltreatment, and type of perpetrator of maltreatment were all associated with initial alliance difficulties. None of these variables predicted change in the alliance over time; instead, severity of interpersonal problems was the best predictor of alliance development. Maltreatment status was not directly related to treatment outcome; however, maltreated adolescents who failed to develop positive alliances with their therapists tended to show the poorest outcomes. Given the strong relationship between alliance formation and outcome, clinical recommendations for therapists who treat maltreated adolescents are presented.