Barriers to Therapy Engagement for Youth in Care: The Influence of the Therapeutic Relationship
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Authors
Timani, Mandi
Issue Date
2026-03
Type
Capstone
Language
en
Keywords
youth in care , therapeutic relationship , attachment theory , trauma-informed care , therapy engagement
Alternative Title
Abstract
The purpose of this capstone was to examine how the therapeutic relationship influences therapy engagement among youth in care, with particular attention to attachment disruption, relational trauma, and systemic instability. Youth in care, including those in foster homes, kinship placements, and residential treatment settings, face significant barriers to engaging in therapy. These barriers are often rooted in disrupted attachments, histories of relational trauma, and systemic instability, which can foster mistrust and resistance in therapeutic contexts. Guided by attachment theory and trauma-informed care, this capstone employed a structured literature review of 50 peer-reviewed and foundational sources published between 1969 and 2025, with the majority of literature drawn from the past 10–15 years. Articles were identified through academic databases including PsycINFO and Google Scholar and selected based on relevance to youth in care, therapeutic engagement, and relational processes. An iterative thematic analysis was conducted to identify recurring patterns across the literature. Findings highlight the critical role of therapist consistency, relational attunement, and nonpunitive responses in fostering safety and trust. Additionally, systemic factors, such as placement disruptions and institutional practices, were found to exacerbate challenges to engagement. Findings suggest that behaviors often labeled as therapeutic resistance should be reframed as adaptive self-protection rather than pathology, underscoring the importance of approaching youth with curiosity and empathy. Implications indicate that strengthening therapist reliability, integrating trauma-informed and attachment-based practices, and addressing systemic barriers are essential for improving therapy outcomes for youth in care. This project contributes to counselling psychology by enhancing understanding of how relational dynamics shape therapy engagement in marginalized child welfare populations.
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License
Attribution-NonCommercial-NoDerivs 3.0 United States
openAccess
openAccess