Young people’s perceptions of therapist interpersonal skills and alliance: How distinct are they?

The aim of this study was to investigate the degree of commonality between young people's perceptions of the alliance and the therapist interpersonal skills (TIS) of empathy, unconditional positive regard, and congruence. Participants were 152 young people (aged 13-16 years old; 114 female, 70 of minoritized ethnicities) who were experiencing moderate to severe levels of emotional symptoms and participated in up to 10 sessions of school-based humanistic counseling. At 6 weeks postrandomization, TIS and the alliance were assessed using the Barrett-Lennard Relationship Inventory: Form OS-40: T-S (Student Form, Version 3) and the Working Alliance Inventory Short Form, respectively. Structural equation modeling was used to identify latent constructs. A model with two correlated second-order factors and a hierarchical model with one third-order general factor exhibited the best data fit. The general factor, which we named youth-perceived relationship quality, explained a substantial amount of variance for TIS (81%) and alliance (98%). TIS and alliance effects, treated independently, explained an additional 3% and 1.4% of variance in satisfaction with care and psychological difficulties after therapy, respectively, as compared with general youth-perceived relationship quality. While therapeutic relationship factors-in clinical practice, training, and research-are often considered distinct, we found a high degree of commonality in how young people perceived the alliance and TIS. Further research is warranted on youth-perceived relationship quality as an integrated variable in youth psychotherapy.