Review: Therapist factors and their impact on therapeutic alliance and outcomes in child and adolescent mental health – a systematic review

• Published in: Child and adolescent mental health 2023-05, Vol.28 (2), p.195-211
• Main Authors: Ryan, Rachael, Berry, Katherine, Hartley, Samantha
• Format: Article
• Language: English
• Subjects: Adolescence; Adolescent; Allied Health Personnel; Child; Child & adolescent mental health; Health services; Humans; Mental Health; Mental health care; Professional-Patient Relations; Psychotherapy - methods; Systematic review; Therapeutic Alliance; therapist characteristics; therapist factors; Therapists
• ISSN: 1475-357X; 1475-3588
• DOI: 10.1111/camh.12518

Background Young people’s mental health is a significant concern globally. The evidence suggests that there is a strong relationship between therapeutic alliance and children’s reported outcomes such as symptoms and dropout of services. There are indications that therapist characteristics – including static qualities and dynamic behaviours – can be associated with both alliance and outcomes. Method The aim of this review was to systematically collate, summarise and critique studies reporting on therapist characteristics that might influence the therapeutic alliance or outcomes for young people accessing child and adolescent mental health services. The Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines were followed, and four databases (PsycINFO, PsycARTICLES, MEDLINE and CINAHL) were searched for ‘therapist’ and ‘characteristic’ combined with ‘alliance’ or ‘outcome’ and related terms associated with these topics. Results A review of 15 papers showed that therapists’ in‐session behaviours and interpersonal style have a significant impact on alliance or outcome. One study also indicated important associations with attachment style. Findings related to ethnicity, gender and level of experience were complex; highlighting differences between subgroups, ages, outcome measurement and diagnostic categories. Methodological issues such as secondary analysis on administrative data confounded the interpretation of results. Conclusions There are indications that specific therapist factors can impact on alliance and outcomes in child and adolescent mental health services. Future research needs to adopt a prospective design and measure therapist characteristics and their relationship to alliance or outcome over time in a broad range of settings.