This scoping review explores the impact of the working alliance (WA) on anxiety and depression outcomes in youth (14–24 years). Analysis of 27 studies, mostly from high-income countries, reveals a positive association between optimal WA and improvements in relationships, self-esteem, coping strategies, optimism, treatment adherence, and emotional regulation. Stakeholder consultations (N=32) highlighted the importance of a favorable therapy environment, regular meetings, collaborative goal setting, and confidentiality for youth, and clinician attributes like boundary setting, confidentiality, communication, non-judgmental attitudes, and empathy. The authors recommend routine WA evaluation and strategies to promote it in youth psychotherapy.
