Clinician\u27s perceptions of the therapeutic alliance and treatment outcomes among juvenile offenders diagnosed with conduct disorder

This qualitative study explored the ways clinicians navigate the therapeutic alliance, treatment approach, and have treatment success with juvenile offenders diagnosed with conduct disorder. Twelve Master\u27s level or higher mental health clinicians were selected through purposive convenience snowball sampling. They were interviewed in person about their use of treatment modalities, techniques and strategies for developing a positive therapeutic alliance and how they have treatment success with these clients. Additionally, they were asked what client characteristics influence their sense of optimism for these clients, what factors contribute to a positive therapeutic alliance, what makes them hopeful/hopeless for these clients, and what hinders/creates a positive therapeutic alliance. Study results indicated the importance of empathy, trust, developing mutual respect, being consistent and allowing the client to be the expert on their own life as the most important factors in developing a positive therapeutic alliance; while judgment, confrontation and anger hinder it. Additionally, despite the challenges of establishing a positive therapeutic alliance with these clients, the majority find this work to be enjoyable. Furthermore, clinicians have more hope that these clients will have brighter futures if they are able to form some sort of attachment with a caregiver, parent, older sibling, or other positive, influential person in their life. Finally, results indicated that the most useful treatment modalities for engaging and working with these clients are motivational interviewing and functional family therapy, however further research is needed