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Abstract
The therapeutic alliance has consistently been shown to be a strong predictor of therapy outcome across theoretical orientations, presenting problems, and modes of treatments in youth (Shirk & Karver, 2003; Shirk, Karver, & Brown, 2011). As the intensity of treatment increases from outpatient to inpatient to residential, the difficulty in alliance formation also increases. Multiple factors can affect a youth’s ability to form an alliance in a residential facility. Internal factors, such as the youth’s psychopathology and temperament, may play a role. Familial factors, including abuse or neglect are common. Community factors, such as being removed from the home, could play a part. Institutional factors, including moving from a lower level to a higher level of treatment, could be another piece of the puzzle. Therapist factors may also play a role.