The therapeutic alliance is considered an important mechanism of change in youth psychotherapy. Accordingly, it has become one of the most investigated psychotherapy variables. Yet, the theoretical and empirical literature on the alliance with young people is complex and has received criticism. This article aims to (a) critically review the existing knowledge on the alliance in youth psychotherapy from its definition to the existing research and (b) discuss some of the implications of this knowledge for clinical practice ad future research. This review highlights that the alliance in youth psychotherapy, as commonly measured, has a significant, although small, impact on outcomes; and that the alliance-outcome association may be influenced by the young person and the therapist's characteristics, as well as therapy types. This points to the importance of finding tailored ways of fostering a strong alliance when working with young people and questions the assumption of the alliance as a generic aspect of all types of youth psychological treatments. Attention to repairing alliance ruptures also emerged as key, especially to preventing early dropout in adolescent therapy. It is argued that despite its limitations, alliance research in youth psychotherapy can have important clinical implications to improve youth psychotherapy. A resumption of a conversation between the clinical and research field on the alliance is needed to better understand the nature and role of this important variable when working with young people and to use this knowledge to inform and improve clinical practice and therapeutic training. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
