Therapeutic Relationships in Child and Adolescent Mental Health Services (CAMHS): TheTRIC studies

  • Rachael Ryan

Student thesis: Doctor of Clinical Psychology


The aim of this thesis was to understand more about therapeutic relationships within child and adolescent mental health services (CAMHS). The thesis is presented as three separate papers. Paper 1 is a systematic review assessing the impact of therapist characteristics on therapeutic alliance or outcomes for children within mental health services. The search strategy is outlined and a narrative synthesis of the findings of the 15 included studies is presented. The strengths, limitations, quality appraisal of the studies are discussed. The review concludes by outlining the research and clinical implications from the available literature. Paper 2 is an empirical investigation of the meaning of the concept of therapeutic alliance for young people, parent and staff who access CAMHS. These three participant groups, completed a Delphi method survey outlining what therapeutic alliance is, how good alliance can be build and what hinders good alliance formation. Findings suggest that the definition of therapeutic alliance in child and adolescent services is different from the widely recognised adult definitions. Furthermore, staff characteristics are considered the most important factor impacting on the quality of alliance. Finally, paper 3 is a critical reflection of the processes involved in conducting the project. This paper provides further detail on the methodology and decision making 6 processes which took place within the research, alongside considering the strengths, limitations, and suggestions for future research. This paper concludes with personal reflections on the thesis project.
Date of Award31 Dec 2020
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKatherine Berry (Supervisor) & Richard Brown (Supervisor)


  • therapeutic relationship
  • mental health
  • alliance
  • adolescent
  • outcome

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