Elusive Alliance: Treatment Engagement Strategies With High-Risk Adolescents

This book is an excellent resource for therapists who work with adolescents. Scholarly reviews are coupled with practical tips on how to enhance the therapeutic alliance, which is vital to clinical success in this age group.---Mary A. Fristad, PhD, ABPP, Professor of Psychiatry and Psychology. The Ohio State University, Columbus

Chaos refers to physical and social settings characterized by crowding, noise, unpredictability or a lack of routines, and instability or unplanned changes. This book explores how, why, and at what level chaos at the familial and societal level affects children. Contributions honor the work of Urie Bronfenbrenner, whose bioecological theory of human development permits study both at the microsystem level and at higher order levels that include parents work environments, the child's local neighborhood, and his or her cultural milieu.

This long-awaited second edition of the best and most authoritative text on this most tragic of subjects incorporates almost 15 years of new research and critical thinking about clinical assessment and intervention in addition to an expanded focus on prevention.

This is the first book to examine systematically the role of the therapeutic alliance in short term psychotherapy and to address the implications of the short-term framework for the alliance, including how time limitations affect the relationship between therapist and client, how therapist and client determine the focus of their work together, and how the therapist deals with ruptures in the working alliance and with the pressure of termination issues.

For some time now, the therapeutic alliance has served as a clinically significant common factor in positive outcomes for adult clients in most types of psychotherapy. Yet it is only recently that the alliance has garnered interest among clinicians and researchers as it relates to adolescents, particularly high-risk adolescents---teens who need mental health treatment services for a variety of disorders peculiar to this age group but who do not have access to these services or who drop out of treatment prematurely.

The more recent interest in the alliance with adolescents has been driven by myriad forces: interested researchers, frustrated clinicians, concerned parents, and policymakers engaged in health care reform. Elusive Alliance examines the conceptual, theoretical, and empirical bases of these forces, providing a picture of the current state of the field as well as an in-depth analysis of some specific programs of research supported by evidence examining adolescent engagement. Researchers and clinicians will be able to establish a more robust knowledge base that will advance our knowledge 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 services 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.