“…It should be noted that present research supports these three factors with adult patients but has not supported these components as making up elements of the alliance with youth patients (Zack, Castonguay, & Boswell, 2007 ) . Karver, Handelsman, Fields, and Bickman ( 2005 ) suggested that the therapeutic alliance in youth therapy consists of an emotional/affective connection (e.g., bond, trust), a cognitive connection (e.g., agreement on goals, hopefulness), and a behavioral connection (e.g., collaboration on tasks and other forms of patient participation).…”