“I saw him as a human being, just an ordinary young person” therapists’ perspectives on therapeutic alliance with youth exhibiting psychopathic traits

Objective: Forming a strong therapeutic alliance (TA) with youth displaying antisocial behavior and psychopathic traits is challenging. This study explores factors influencing TA in therapy informed by Compassion-Focused Therapy (CFT), identifying key themes and strategies. Method: A qualitative study using semi-structured interviews with ten Finnish therapists experienced in working with this population. Participants used a CFT-based intervention designed to reduce psychopathic traits, shame, and fears of compassion. Data were collected between June and October 2024 and analyzed using thematic analysis. Results: Key themes influencing TA included respectful encounter, common humanity, trust, non-judgment, safeness, and stability. Therapists employed warmth, empathy, humor, and self-compassion techniques to strengthen TA. They emphasized consistency, clear communication, emotional validation, and an unhurried therapeutic presence to foster trust and engagement. Conclusion: Despite challenges, a strong TA with youth exhibiting psychopathic traits is achievable and critical for treatment success. CFT's emphasis on empathy, non-judgment, and stability supports TA formation. Specific strategies, such as warmth and consistency, help overcome engagement barriers and facilitate meaningful therapeutic relationships.