(PS9-88) Addressing Power Imbalance in the Therapeutic Alliance in Youth CBT Treatment: A Thematic Analysis

The therapeutic alliance has been identified as one of the most important predictors of treatment engagement and outcomes. Clients from minoritized groups such as BIPOC, LGBTQ+, and low socioeconomic status frequently experience poor therapeutic alliance and therefore worse treatment outcomes due, in part, to experiences of mistrust, microaggressions, and feeling misunderstood by their provider. Literature guiding clinicians in how to consider cultural context and the imbalance of power between themselves and their clients within the context of Evidence Based Treatment (EBT) is lacking. More research is needed for clinicians to have clear guidance on best practice for developing culturally responsive therapeutic alliances. This study centers youth client, caregiver, and clinician perspectives to better understand strategies that address the power imbalance within the therapeutic relationship and contribute to a strong therapeutic alliance. Clinicians (N=16), youth clients (N=10), and caregivers (N=7) were recruited from a specialty anxiety clinic in Philadelphia, Pennsylvania serving youth in the public mental health system to participate in qualitative interviews regarding their perceptions of care, including the therapeutic alliance. Analyses are guided by inductive and deductive qualitative methods; grounded theory is used to allow themes to emerge from the data, and framework analysis will be used to identify a-priori attributes of the therapeutic alliance in the current literature (e.g., cultural humility, discussing social identities) that presented themselves in the interviews. Qualitative interviews were conducted, and analyses are underway. Preliminary themes suggest important components of balancing power between clients and clinicians include acknowledging (mis)matched social identities, collaborative decision making, client empowerment, and transparent communication about the treatment process. These results can inform clinician training on incorporating cultural context and awareness of power structures into the development of the therapeutic alliance, which in turn has the potential to improve treatment outcomes for minoritized youth receiving EBT.