Pre-treatment profiles of adolescent girls as predictors of the strength of their working alliances with practitioners in residential care settings

Given the importance of the working alliance to achieve positive outcomes in various types of treatment, it is important to better understand the factors that contribute to a good alliance. The present study aimed to determine which configuration of pre-treatment characteristics predicted a higher or weaker working alliance between 175 adolescent girls in residential care and their practitioners. Girls' self-reported pre-treatment characteristics (behavior problems, trauma-related symptoms, interpersonal problems and attitudes toward change) were assessed soon after admission in treatment and the working alliance was assessed three months later by both girls and their designated practitioner. Latent class analysis revealed three different profiles of girls at admission: “fewer problems”, “distressed” and “more/externalizing problems”. Findings indicated that girls with “more/externalizing problems” were 7.9 times more likely than girls from the “distressed” group to report a weaker working alliance. However, girls' pre-treatment profiles did not predict practitioners' assessment of the quality of their working alliance. Implications for research and practice are discussed.