Psychotherapists\u27 Experiences of a Therapeutic Alliance with Children on the Autism Spectrum

The therapeutic alliance has been identified as especially important to positive therapeutic outcomes in child psychotherapy, yet few studies have focused on the meanings of an alliance with children with autism and how the alliance develops and is maintained. Using phenomenological qualitative methodology, this study aimed to increase an understanding of the meanings of an alliance with children with autism for therapists working with them in the context of psychotherapy. Eleven therapists with therapeutic experience with children with autism were interviewed and yielded the following description of the essential meanings of an alliance: the patient feels safe and emotionally close to the therapist, feels motivated to go to therapy, safe and comfortable enough to share or begin to explore their feelings and concerns, is more willing to “buy into” challenging tasks and is amenable to therapeutic interventions. Participating therapists described gauging their alliance through observation of these characteristics, behavioral cues in their patients, and their feelings during interactions with them, noting that being aligned with their patients feels less effortful and rewarding. Participants also identified the following components to be present to varying degrees in the process of forming an alliance across patients with autism: joining patients in their interests; learning and accommodating patients’ developmental differences; identifying the meaning of patients’ behaviors and communications; being non-judgmental, validating, respectful and having positive regard for patients; creating a positive, non-demanding and predictable therapeutic environment; having a reflective process and supervision; and caregiver engagement