Aim A startling number of adolescents have mental health problems, yet research on the effect of routine care shows sobering effect sizes and high dropout rates. This study's objective was to gain in‐depth, first‐person knowledge about what adolescents need from their therapists to engage therapeutically and benefit from treatment. Method A total of 22 adolescents aged 14–19 years participated in qualitative focus groups or individual interviews of their own choosing. The data material was analysed using a systematic, step‐wise and consensual qualitative research framework for team‐based analysis. Findings Six themes emerged from the analysis, named from the words of the adolescent participants: (1) facing a scary situation: Attend to the adolescent's starting point, (2) be warm, invested and emotionally engaged, (3) offer live company and presence as a real human being, (4) have integrity as an adult and a professional, (5) know the world of a teenager and get into their stories and (6) have mutuality as a virtue and treat the adolescent as an equal. Discussion and implications Overall, adolescents regard the quality of the therapeutic relationship with their therapist as essential for the success of psychotherapy. In terms of their needs in treatment, therapists need to overcome the adolescents’ initial misgivings and scepticism towards therapy through establishing trust and accommodating their developmental desire for autonomy and connectedness.

BackgroundIn line with the evidence-based paradigm, routine outcome monitoring and clinical feedback systems are now being recommended and implemented in youth mental health services. However, what constitutes a good outcome for young service users is not fully understood. In order to successfully monitor outcomes that are clinically and personally relevant for the service user that are to benefit from these systems, we need to gain more knowledge of what young service users value as meaningful outcomes of youth mental health services.AimTo contribute knowledge into what constitutes “good outcomes” from the experiences of adolescent service users in public mental health systems.MethodsA qualitative in-depth study of the experiences and reflections from 22 adolescents aged 14–19 years, currently or recently being in public mental health services. The data material was analyzed using a systematic step-wise consensual qualitative research framework for team-based analysis.ResultsAn overarching theme of outcome as having developed a stronger autonomy and safer identity emerged from the analysis, with the subsequent five constituent themes, named from the words of the adolescent clients: (1) I’ve discovered and given names to my emotions, (2) I’ve started to become the person that I truly am, (3) I’ve dared to open up and feel connected to others, (4) I’ve started saying yes where I used to say no, and, (5) I’ve learned how to cope with challenges in life.Conclusion“Good outcomes” in youth mental health services should be understood as recovery oriented, sensitive to developmental phases, and based on the personal goals and values of each adolescent client.

Although the effect of the therapeutic alliance on psychotherapy outcome is well documented in the research literature, less is known about how the alliance is developed during the first sessions of therapy. This qualitative meta-analysis aimed to summarize and reanalyze the existing qualitative research literature on alliance-formation processes from the perspectives of therapists and clients. Research articles were obtained through systematic searches in the following databases: PsycINFO, MEDLINE, and Web of Science. Initially, 1,006 nonduplicate articles were screened, resulting in 15 articles that explored early alliance-formation processes from the perspectives of therapists and clients. These articles were analyzed using an existing framework of meta-analyzing qualitative research. Nine articles that studied the client perspective revealed 5 overarching metathemes: (1) meeting a competent and warm therapist;(2) being understood as a whole person; (3) feeling appreciated, tolerated, and supported; (4) gaining new strength and hope for the future; and (5) overcoming initial fears and apprehension about psychotherapy. Seven articles that studied the therapist perspective revealed 6 overarching metathemes: (1) balancing technical interventions and interpersonal warmth; (2) showing a genuine desire to understand; (3) openly supporting client agency; (4) adjusting to create a sense of safety; (5) paying attention to body language; and (6) providing helpful experiences during the first session. As the first of its kind, this meta-analysis of the dual perspectives of therapists and clients shows thematic commonalities and divergences in how alliance development is experienced. Clinical implications of how alliance development can be promoted in clinical practice are discussed.

Objective: Routine outcome monitoring and clinical feedback systems might be beneficial for adolescent psychotherapy processes. Methods: Clinicians (n = 34) and adolescent clients (n = 22) aged 14-19 from seven different outpatient clinics located in Norway participated in the study. Adolescents were interviewed in individual in-depth interviews (n = 7) or in four adolescent-only focus groups (n = 15), clinicians participated in seven clinician-only focus groups. Results: We report two core domains, (1) feedback about the therapeutic relationship and (2) feedback about the therapeutic work. Seven subthemes specify the functionality that participants need in a feedback system. Conclusion: Adolescents and therapists requested a feedback system that was relationally oriented, supported collaborative action, and was personalized to the needs of the individual adolescent. The research indicates that a clinical feedback system should have idiographic, as well as nomothetic, components. A clinical feedback system for adolescents should monitor experiences of personal autonomy and the quality of the therapeutic relationship.