Building Trust in Therapy for Teens: The Importance of Therapeutic Alliance in Attachment Repair
If your teen struggles to open up, whether because of past trauma, anxiety, or just the emotional rollercoaster that adolescence can bring, therapy can be a lifeline. But only if a teen feels safe, seen, and supported.
At the core of successful therapy lies trust. However, building trust in therapy for teens isn’t automatic and can be challenging for those with insecure attachment patterns. An insecure attachment can create a mental template for teens in which relationships don’t feel safe, potentially affecting connections with others throughout life.
The alliance between therapist and client is essential for healing. As a parent, understanding the importance of a therapist relationship for insecure attachment can help you to support your teen through their therapeutic journey.
At Mission Prep, the therapeutic alliance is at the heart of our practices. If you’d like to learn more about how this relationship can help your teen heal from trauma or mental health conditions, our team is happy to discuss it with you.
This page can also help, as it explores:
- What attachment is
- What the therapeutic alliance involves
- Why a therapist’s attachment matters during therapy
- Ways to improve the therapy connection
- Therapeutic approaches that support attachment repair
- Which mental health programs may be useful for repairing the attachment bond
- Where to find professional support for insecure attachment
Understanding Attachment in Teens
For many parents, attachment theory brings clarity to the confusing emotional ups and downs that can’t be explained by typical “adolescent hormones.” In this section, you’ll discover the basics of attachment theory and how attachment can impact adolescents.
Attachment Theory Essentials
Attachment theory was created by John Bowlby, a psychologist, as a way to explain how the emotional connections we make with caregivers form a blueprint for all future relationships. He believed that when an infant’s needs are fulfilled consistently and accurately by their parent or caregiver, the child will form a secure attachment.
To put secure attachment simply, this early relationship with caregivers teaches the child that they are worthy of love and support. It also helps them learn that other people can be trusted and their emotions can be managed.
Alternatively, if the child’s needs were inconsistently met or if they experienced neglect or frightening care, they may instead develop an insecure attachment style.
Just as a child with a secure attachment typically has a positive template of themselves and others, a child with an insecure attachment will also have a mental blueprint. However, their mental blueprint tends to be maladaptive. For example, their understanding of how the world works may include the messages that they cannot depend on others and that others can’t be trusted. This template may even include the belief that they themselves are not worthy of love.1
Impact of Insecure Attachment on Teens
During adolescence, insecure attachments may show up as anxiety, avoidance, or difficulties forming healthy relationships with others. Teens may also isolate themselves or people-please to avoid being rejected or hurt. However, patterns of behavior can differ depending on the type of attachment a teen has, including where on the dimension of attachment their beliefs fall.
There are three insecure attachment styles in total, each with its own unique presentation in adolescents.2 You can read more about these types by visiting the pages below:
In general, a teen with anxious attachment may fear abandonment, so they’re often hypervigilant to threats to their important relationships. This hypervigilance can lead to what’s often perceived as “clingy” behaviors. However, they can also self-sacrifice their own needs in attempts to win the approval of others and keep them close. Teens with this attachment style tend to have a low self-view, but a high view of others.
In contrast, a teen with avoidant attachment may have a high self-view and a low opinion of others. Yet, this high self-view is often used to mask a low sense of self-worth. Because they expect others to reject or hurt them, teens with this attachment style may have a premature sense of independence. This may cause them to withdraw from others and come across as a “lone wolf.” In general, emotional intimacy can be frightening to them.
Disorganized attachment tends to alternate between the dimensions of attachment anxiety and avoidance, meaning that teens with this style can show contradictory, or “chaotic” behaviors in relationships. This comes down to how this attachment style forms in environments where caregivers are both a source of safety and fear.
Repairing Attachment Wounds – Is It Possible?
Infants subconsciously develop attachment styles as attempts to stay connected and protected in their earliest relationships. Likewise, teenagers may not know why they behave the way they do, as their attachment was not a conscious choice. However, insecure attachment styles can continue through someone’s life if they don’t experience healing.
Yet, although attachment styles are stable traits, they’re still malleable to change. With reparative experiences, awareness, and consistent effort, it is possible for a teen to form a more secure attachment. The therapeutic relationship can play an important role in this process.
What Is the Therapeutic Alliance?
At the heart of successful and effective therapy is the therapeutic alliance. This is the relationship between the therapist and client, which encompasses mutual respect, empathy, non-judgmental attitudes, and a collaborative and trusting bond.
The therapist and client work together as a team rather than one person being taught or lectured by the other.3 These qualities allow a teen to feel safe enough to open up to a therapist about their concerns.
Engagement in therapy can be challenging for some teens. For instance, if they’ve been “told” to go to therapy by their parents or doctors, rather than making the choice for themselves. This is why forming a strong therapeutic alliance is particularly important in adolescents. Teens need to feel comfortable and safe to open up about the issues closest to them, which can only happen once trust builds between them and their therapist.
Research also confirms that a strong therapeutic alliance is one of the most important predictors of successful therapy. It also shows that the alliance tends to consist of three main themes, including:4
- Collaboration in the relationship
- Bonds between client and therapist
- The ability of the patient and therapist to agree on treatment goals and tasks
A good, strong therapeutic alliance provides your teen the opportunity to experience a consistent, caring relationship with an adult who listens without judgment, maintains healthy boundaries, and is emotionally present. Even when things get tough, the therapist maintains these qualities. This bond can offer a strong base for adolescents to challenge their assumptions about themselves and the world, gain new positive experiences, and heal.
How Therapist Attachment Impacts Treatment Outcomes
Everyone has an attachment style – even therapists. And in the same way that a teen’s attachment may influence their behavior and attitude, a therapist’s attachment style can impact how effective treatment is.
Overall, a therapist with a secure attachment is the “ideal” in therapy. They often have a positive impact on the process and outcome of therapy, can regulate their own emotions, and build healthy and secure relationships with clients.5 Plus, they can model what secure attachments look like.
However, this information doesn’t mean that therapists with insecure attachments should be disregarded. In fact, research studies have found that when a client and therapist with opposing attachment styles work together (anxious and avoidant), they can have productive relationships and successful outcomes.6-8
But regardless of a therapist’s attachment style, a skilled therapist should be able to adapt their approach to build trust and facilitate the healing process.
Strategies for Improving Therapy Connection
The therapeutic relationship doesn’t just “happen.” It takes time, just like any relationship. It also takes consistency and trust.
Indeed, the importance of consistency in therapy cannot be minimized, especially as people struggling with insecure attachment have often experienced inconsistency of some sort in their upbringing.
Seeing the same therapist regularly, in either the same or a predictable environment, can help to create a sense of safety. Keeping this predictable therapy routine means a teen knows what to expect. They understand that their therapist will be present, listen to them, not judge them, and respond to them from a place of care.
Therapist Strategies for Creating a Secure Alliance
Therapists may use a variety of techniques to foster a trusting connection with the teen and enhance their therapeutic relationship. For instance, they may share their thoughts and feelings appropriately and with congruence to build trust.
Active listening skills are also invaluable, as they help them to understand their client and to gently share what they notice about them or what they are saying. This allows teens to feel truly seen and heard.
Awareness of their own attachment style also facilitates a therapist in identifying a teen’s patterns of behavior and creating repairing experiences. They can bring this awareness into a range of therapeutic modalities, informing how they deliver them.
Each of these skills contributes to deepening the connection between client and therapist, creating trust and openness in teens who may be used to withdrawing or feeling misunderstood by others.
How Parents Can Encourage Therapeutic Connection
As a parent, you may be under the impression that there isn’t anything that you can do to help your teen connect with their therapist. While this is a common misconception, there are several ways you can help your teen build this connection. For instance, you could:
- Encourage your teen to stick with therapy
- Be patient with them while they are on their journey of self-exploration
- Manage their expectations. For instance, reminding them that therapy won’t “fix” things overnight
- Provide consistent emotional support outside of sessions
- Understand your own attachment style and behavior patterns
Be supportive and understanding of your teen and their process of healing. There will inevitably be ups and downs, and perhaps even times when it feels as though progress has stalled. Therapy isn’t always a linear process, yet a strong therapeutic alliance and connection between therapist and client can pave the way toward healing.
Therapeutic Approaches That Support Attachment Repair
With so many different therapies to choose from, it can be difficult to know which options are most effective for healing attachment. The main things to consider are that the approach should prioritize emotional safety in counseling for teens, alongside creating a strong and stable therapeutic relationship. These factors can create the circumstances needed for recovery to take place.
Approaches that emphasize adolescent trust-building in therapy can help teens to feel seen, safe, and supported. Below are some of the therapeutic models that can be particularly effective at fostering relationships required for attachment repair.
- Attachment-based family therapy (ABFT): In ABFT, the family unit is treated as a whole. This therapy, grounded in attachment theory, can help the family create secure emotional bonds and heal early childhood attachment wounds.9
- Emotionally focused therapy (EFT): EFT aims to reshape negative relationship patterns. It’s grounded in attachment theory and focuses on emotional regulation, self-identity, and relationships with others.10
- Cognitive behavioral therapy (CBT): CBT enables teens to recognize unhelpful thoughts, behaviors, and emotions, challenge them, and form healthier alternatives and coping strategies.11
- Trauma-informed therapy: Therapy with a trauma-informed therapeutic alliance allows teens to process traumatic experiences from early childhood in a safe space. They can learn how to manage symptoms, such as flashbacks and avoidance of triggers, and learn healthier coping mechanisms.12
- Dialectical behavior therapy (DBT): DBT is a therapy where teens can learn the skills needed to regulate their emotions, such as improving their communication skills and finding ways to cope with distress.13
Mental Health Programs Focusing on Therapeutic Bond
Outpatient therapy options, such as the ones mentioned above, are often effective for repairing attachment wounds. However, sometimes a more intensive approach is needed, especially if there is trauma, risky behaviors, or complex mental health needs involved. This is the point at which you may want to consider either intensive outpatient programs or residential programs with strong therapeutic support.
An intensive outpatient program allows teens to spend their evenings and nights in the comfort of their home and spend their daytimes focusing on their recovery. This may involve face-to-face therapy sessions, education, medication management, or anything else needed to support their healing.
A residential program provides a safe and supportive environment for a teen to heal from their challenges. They can give round-the-clock care as well as a full program of activities and sessions to fully support a teen.
When considering programs, it’s essential to look for ones that have staff consistency, use attachment- and/or trauma-informed approaches, and value the involvement of family members in the healing process.
Remember that with the right help and support, recovery is achievable. Your teen can experience healthier, fulfilling relationships, feel more confident in themselves, and be better equipped to face their future.
Supporting Your Teen’s Healing With Mission Prep
Rebuilding trust and repairing attachment wounds isn’t a quick process, but with the right therapeutic alliance, healing is entirely possible. As a parent, your support, patience, and understanding are vital, even when progress feels slow.
The connection your teen forms with their therapist can be an impactful healing experience that fosters emotional safety, resilience, and long-term recovery. At Mission Prep, we specialize in attachment-focused, trauma-informed care for teenagers, with programs designed to build strong therapeutic relationships and lasting change.
If you’re wondering which approach is best for your family, we can help you. Contact us today to learn more about our teen therapy programs and how we can support your teen – and family – in moving toward a brighter tomorrow.
References
- McGarvie, S., PhD. (2025, March 27). Attachment Theory, Bowlby’s Stages & Attachment Styles. PositivePsychology.com. https://positivepsychology.com/attachment-theory/
- Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41(1), 49–67. https://doi.org/10.2307/1127388
- Opland, C., & Torrico, T. J. (2024, October 6). Psychotherapy and therapeutic relationship. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK608012/
- Stubbe, D. E. (2018). The therapeutic alliance: the fundamental element of psychotherapy. FOCUS the Journal of Lifelong Learning in Psychiatry, 16(4), 402–403. https://doi.org/10.1176/appi.focus.20180022
- Horne, S. J., Liu, S., & Doorn, K. A. (2024). The role of therapists’ attachment and introject in their treatment process and outcome: A Systematic review. Clinical Psychology & Psychotherapy, 31(5). https://doi.org/10.1002/cpp.3043
- Parpottas, P., & Draghi-Lorenz, R. (2015). Theoretical Paper Effects of therapists’ attachment organisation on the process and outcome of therapy: A review of the empirical literature. Counselling Psychology Review, 30(4), 44–56. https://doi.org/10.53841/bpscpr.2015.30.4.44
- Dozier, M., Cue, K. & Barnett, L. (1994). Clinicians as caregivers: Role of attachment organisation in treatment. Journal of Consulting and Clinical Psychology, 62(4), 793–800
- Tyrrell, D.L., Dozier, M., Teague, G.B. & Fallot, R.D. (1999). Effective treatment relationships for persons with serious psychiatric disorders: The importance of attachment states of mind. Journal of Consulting and Clinical Psychology, 67(5), 725–733.
- Ewing, E. S. K., Diamond, G., & Levy, S. (2015). Attachment-based family therapy for depressed and suicidal adolescents: theory, clinical model and empirical support. Attachment & Human Development, 17(2), 136–156. https://doi.org/10.1080/14616734.2015.1006384
- Johnson, S. M. (2009). Attachment theory and emotionally focused therapy for individuals and couples: Perfect partners. In J. H. Obegi & E. Berant (Eds.), Attachment theory and research in clinical work with adults (pp. 410–433). The Guilford Press. https://psycnet.apa.org/record/2009-02347-016
- Herres, J., Krauthamer Ewing, E. S., Levy, S., Creed, T. A., & Diamond, G. S. (2023). Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety. Frontiers in Psychiatry, 14, 1096291. https://pmc.ncbi.nlm.nih.gov/articles/PMC10165080/
- National Health Service (NHS) (2022, August 1). Complex PTSD – Post-traumatic stress disorder. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/complex/
- Flechsig, A., Bernheim, D., Buchheim, A., Domin, M., Mentel, R., & Lotze, M. (2023). One Year of Outpatient Dialectical Behavioral Therapy and Its Impact on Neuronal Correlates of Attachment Representation in Patients with Borderline Personality Disorder Using a Personalized fMRI Task. Brain Sciences, 13(7), 1001. https://doi.org/10.3390/brainsci13071001
