“You have to have the relationship”: a youth perspective on psychotherapy and the development of a therapeutic relationship

This study used qualitative methodology to examine the opinions of adolescents regarding the formation of a therapeutic relationship and engagement in individual therapy. Adolescents face the challenge of coping with significant and concurrent biological, psychological, and social changes while completing a variety of developmental tasks, including identity formation, separation from caregivers, and gaining peer acceptance. The stress of having to navigate through this developmental period can often manifest as mental illness, requiring therapeutic intervention. However, due to the unique developmental issues facing adolescents, it is more difficult to conduct therapy with this age group. In particular, the task of forming a therapeutic relationship, which is a critical component of successful therapy, is more challenging with adolescents than any other age group. Given the significant emotional distress experienced by adolescents today, in combination with their negative attitudes towards, and dissatisfaction with, therapeutic services, it is necessary to determine methods for optimizing the benefits received from these services. An effective approach to service enhancement is to solicit the opinions of consumers and integrate these findings into practice. In the present study, fifteen adolescents with extensive experience in individual therapy were interviewed and a qualitative analysis using grounded theory was conducted. The adolescents discussed the ideal ways in which they would want therapists to interact with them to facilitate the formation of a strong therapeutic relationship. Four therapist attributes or qualities were identified, including respect, responsiveness, “genuine caring”, and authenticity. Respect denotes the importance of an egalitarian and accepting relationship, while responsiveness involves tailoring the therapy experience for each youth. “Genuine caring” includes being sincerely interested in and committed to the youth, while authenticity highlights the value of therapists revealing their personalities. The adolescents also discussed the structural aspects of therapy that were perceived as being beneficial, such as “venting” to someone who is “removed” from their social and family lives, as well as the challenges associated with the initial stages of therapy. The clinical implications of these findings and the obstacles to providing youth with their ideal experience are discussed.