I’d like to talk about a concept known as the therapeutic alliance. In the first half of this presentation, I’ll introduce you to the TA and some of the personality characteristics associated with a strong TA. In the second half of the presentation, I will talk about some of the work we are doing at PR to promote the TA and create strong bonds between students and staff.

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Clearly there is a need for serving students' mental health needs in schools. As many as 1/5 of a school’s population may meet the diagnostic criteria for a mental health disorder (Rones & Hoagwood, 2002). These students often experience many different struggles and challenges. Of course, we know that even the most challenging child can grow in competence and succeed. However, no lasting change can occur without a trusting, caring relationship.

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Bryan’ story. Bryan came to us as a very troubled young man. He was abandoned by his mother when he was 10 years old. Since then, he had been in and out of multiple foster care placements. When he arrived at our school, Bryan did not trust staff and was highly disrespectful and noncompliant. At first, whenever our staff tried to talk about his problems, he would become resistant or aggressive. However, staff members were persistent and continued to try to engage Bryan.

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Over time, Bryan developed a great relationship with his teacher and began to open up. His teacher discovered that he was incredibly smart, and was a gifted artist. Through this connection, Bryan began to make significant progress, improving his behavior, and increasing his grades. Eventually, his aunt agreed to take custody of Bryan once he was ready to transition back to public school. Unfortunately, she went back on this promise and Bryan regressed. Once again, he began to exhibit troubling behaviors and refused to participate in school.

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Bryan expressed to his staff that he felt as if all of the adults in his life let him down, and that he was unlovable. Through their continued commitment to Bryan and his well-being, staff were able to demonstrate that he, too, could be loved. He eventually improved his behavior, graduated high school, and went to college in RI for art. Years later, Bryan still calls his classroom teacher to talk and inform her of his progress. He has said that if is wasn’t for her, he would be “in jail or worse.” This story describes the power of the TA.

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Loosely defined, the TA is a positive, trusting working relationship between someone providing treatment and a consumer. For purposes of this presentation, I will be talking about the TA between adults in schools and the children & adolescents they serve. The TA acts as a secure base for helping youth overcome challenges associated with their mental health conditions or turbulent home lives. Moreover, a strong TA between a school staff member and a child can become a model for future relationships with adults. In essence, the TA can be a foundation for change. There is over a decade of research that demonstrates that a strong TA is related to treatment success.

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But the TA is more than just a supportive relationship. For the TA to be optimally successful, staff and students must agree on the goals of treatment, as well as the tasks required to reach those goals. It’s working together to achieve a common goal. This is important because some studies have shown that adults and children’s perceptions of the TA may be different. In their 2001 study, Doucette & Bickman asked youth to identify adult characteristics that help to establish a supportive, working relationship. I will briefly review some of these characteristics here.

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Perhaps the most important characteristic of a strong TA identified by students was trust. Many kids who are referred for treatment struggle to connect with adults, so it is important to establish a trusting bond between the child and the staff member. It stands to reason that youth may not listen to someone that they do not trust! Nicholas Hobbs (1994) defined trust between a child and an adult as “the glue that holds teaching and learning together.” In this sense, trust is the bedrock of the TA.

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Students also identified consistency and flexibility as important characteristics of the TA. They want adults to set reasonable, consistent expectations without being inflexible. Anyone who works with at-risk youth knows that if you are a pushover, they can walk all over you. So it is important to have high expectations and to be consistent with those expectations. However, it is just as important to understand that sometimes you will need to be flexible in applying those expectations and open to change.

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Another characteristic identified by youth is one that we call can relate to, and that’s being a good listener. Youth want staff members to be able to listen to their problems without being overly critical. They want their feelings to be validated, not dismissed. A staff member who actively listens to youth and responds with sound advise is likely to viewed in a positive light.

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The last TA characteristic that students’ identified was persistence. Kids want adults that realize that they may experience setbacks during treatment. They may have a history of adults who give up on them. Sticking with students through times of adversity is beneficial towards building a strong therapeutic relationship.

Working with troubled youth is very challenging; we often experience setbacks or have to deal with forces beyond our control. It is important to remain strong and help children work through these tough issues, often in the face of very intense behaviors.

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Hobbs also said that “Time is an ally.” Time must be afforded to the process of teaching and learning. Developing a strong TA does not happen overnight. One study found that the trajectory of the TA between adults and kids is U shaped (Manso & Rauktis, 2011). The development of youth occurs over time, and so, too, will their successes.

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What are we working on? Promoting the use of the TA in our schools. I will now talk about how we are trying to incorporate the research behind the TA to improve our supports for children with EBD and autism.

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The first application of the TA that we are exploring is infusing training and supervision with elements of TA. We have begun to have staff and students complete TA scales. The data from these scales will be used to inform weekly supervision. In addition, the TA data will be used to provide targeted training towards areas of need.

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Another thing we are trying to do is use our knowledge of what characteristics are important for creating the TA to inform hiring practices. As you know, burnout rates amongst special education teachers and those working with troubled youth are staggeringly high. As one of our teachers told me the other day, “you have to be a special kind of person to work here.” We experience a high rate of staff turnover at our schools.

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Correlating TA to personality characteristics to inform for hiring practices Survey staff using personality inventories (Cattel’s 16pf) and behavior-based interviewing to see how their personality matches with child-desired characteristics (warmth, flexibility, emotional stability, etc.).

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Providing students with activities that help them to bond with staff and form that close connection. Providing opportunities for activities outside the routine and ritual of the normal treatment day. In these activities an even greater sense of community and belonging is developed.

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Increasing the opportunities our kids have to engage with staff members in areas outside of the school: camping trips, nature hikes, trips to the library, etc. These activities are not just for fun; there is a degree of therapeutic intentionality.

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Of course, staff and students must also work on their relationship while in school. One of our new initiatives is to reduce the reliance on tangible or artificial reinforcers and replacing them with more naturally occurring alternatives such as staff attention or time with staff.

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There are also other facets of the TA that we would like to explore and research. For example, what does the TA look like in other populations, such as students with autism? What about the current generation? Has there been a shift in the way that children or adults view the TA over time? The possibilities are limitless.

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