Manifestations of the therapeutic alliance in children and adolescents

Building the therapeutic alliance is a creative process and is a central issue for all age groups. In the absence of an alliance, there can be no therapy. The alliance contains many primitive sources for collaboration with the therapist. It is a combination of both rational and irrational elements. The therapist's awareness of developmental issues and defense mechanisms are utilized to guide one along the pathway of productive therapy. In addition, the unique psychodynamic factors are considered when working with children and adolescents. The clinical examples distinguish pitfalls which are destructive and could be avoided, in contrast with understanding and responding appropriately to the verbal and nonverbal communications of the young patient.This paper was presented to the International Conference for the Advancement of Private Practice of Clinical Social Work, Rio de Janeiro, Brazil, August 1987. Ms. Marcus is in private practice in New Orleans.