The impact of working alliance in managing youth anxiety and depression: a scoping review

A working alliance (WA) signifies a collaborative relationship between client and therapist and is essential across psychotherapies in adults. Critical gaps remain regarding WA in low-intensity therapies for young people. This initiative explored the effect of WA on anxiety and depression outcomes in youth aged 14–24 through a scoping review and stakeholder consultations (N=32). Twenty-seven studies were analysed, mostly in high-income countries and evaluating one-on-one in-person therapies (18/27). Optimal WA was associated with improvements in relationships, self-esteem, positive coping, optimism, adherence, and emotional regulation. Young people reported that a favourable therapy environment, regular meetings, collaborative goal setting, and confidentiality are vital to forming and maintaining WA. Clinicians highlighted boundaries, confidentiality, communication skills, non-judgmental stance, and empathy as essential. A functional WA was recognised as an active ingredient in therapies for youth anxiety and depression. Routine evaluation of WA and strategies to promote WA are recommended; further research is needed to clarify mechanisms and effects in diverse contexts.

Jermaine M. Dambi, Webster Mavhu, Rhulani Beji-Chauke, Malinda Kaiyo-Utete, Rhiana Mills, Ruvimbo Shumba, Sidney Muchemwa, Rosemary Musesengwa, Ruth Verhey, Melanie Abas, Colette R. Hirsch, Dixon Chibanda