Elusive Alliance Treatment Engagement Strategies With High-Risk Adolescents

For some time now, the therapeutic alliance has served as a clinically significant "common factor" in positive outcomes for adult clients in most all types of psychotherapy. Yet among adolescents, the alliance has garnered interest among clinicians and researchers only relatively recently, particularly in cases of "high-risk" adolescents-teens who need mental health treatment services for a variety of disorders peculiar to this age group (e.g., anxiety disorders, depression, externalizing/disruptive behavioral disorders, etc.) but do not have access to these services or drop out of treatment prematurely. The more recent interest in the alliance with adolescents appears to be driven by myriad forces: interested researchers, frustrated clinicians, concerned parents, and policymakers engaged in healthcare reform. Elusive Alliance examines the conceptual, theoretical, and empirical bases of these myriad forces, presenting some of the highly promising work that has been accomplished over the past two decades on engaging high-risk adolescents in psychotherapy. By getting a picture of the current state of the field while also getting an in-depth analysis of a few specific programs of research supported by evidence examining adolescent engagement, researchers and clinicians alike will be able to establish a more robust knowledge base that serves to advance future treatment process research on how to engage the challenging and underserved population of high-risk adolescents. Beyond the practical appeal to researchers and clinicians, this book will be of vital interest to scholars, practitioners, and policymakers at all levels who are involved in making mental health service delivery for youth more accessible and more cost-effective.

David Castro-Blanco, PhD, ABPP, is the director of the doctoral program in clinical psychology at the Adler School of Professional Psychology in Chicago, where he also teaches courses on cognitive-behavioral intervention and research design. He received his doctorate in clinical psychology from St. John's University in New York and completed a National Institute of Mental Health-sponsored postdoctoral fellowship at New York State Psychiatric Institute, where he specialized in adolescent suicide prevention. His research focuses on identifying and treating anxiety in young people and enhancing treatment engagement with adolescents at risk for treatment dropout. Before joining the faculty at the Adler School, Dr. Castro-Blanco served on the psychology faculties of the Philadelphia College of Osteopathic Medicine, Long Island University, and St. John's University. In addition, he served as a senior clinician at the American Institute for Cognitive Therapy in New York for 2 years. He holds the Diploma in Clinical Psychology from the American Board of Professional Psychology and has served as an editor or reviewer for several professional journals.
Marc S. Karver, PhD, is a licensed clinical psychologist and an associate professor of psychology at the University of South Florida, Tampa. He received his doctorate in clinical psychology from Vanderbilt University, Nashville, Tennessee. His research interests include the evaluation and improvement of the quality of real-world mental health services for children and adolescents. He has focused on addressing the three areas that define quality mental health services: structure, measurement of treatment processes, and outcomes (both positive and maladaptive). His work has focused on studying the provision of mental health prevention and intervention services to at-risk populations, such as suicidal adolescents. He has a number of highly cited publications focused on the measurement of treatment engagement processes. Dr. Karver has designed or collaborated on numerous studies involving assessment, treatment decisions, intervention, or prevention services delivered to suicidal youths. His research has been supported by the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration.