Understanding mental health professionals' perspective of therapeutic alliance in working with unaccompanied children: A grounded theory approach

The number and trends of unaccompanied children immigrating to the U.S. has drastically changed throughout the years and many are placed in shelters while they remain in the custody of the Office of Refugee Resettlement (ORR). Unaccompanied children subject to traumatic experiences in their country of origin or throughout their journey present with high levels of adverse mental health. Despite this, there is limited literature exploring the mental health concerns of unaccompanied children or the experiences of mental health professionals serving unaccompanied children specifically unaccompanied children in ORR care. This study aimed to understand the perception of mental health professionals of establishing therapeutic alliance with unaccompanied immigrant children in an ORR shelter. Grounded theory methods were utilized to identify elements vital to the process of building therapeutic alliance with unaccompanied immigrant children. In this qualitative study data was drawn for 6 participants providing mental health services to unaccompanied immigrant children in ORR shelters in South Texas. The pressing elements identified were, policy impacts treatment, boundaries, limitations due to setting, cultural competency, creating a safe environment and impacts of COVID-19. Understanding how these elements present themselves and how to address them in the process of developing therapeutic alliance is crucial. Future research should include a specific focus on building therapeutic alliance in other ORR settings. More work can be done to educate communities and other mental health professionals about the efforts and practices necessary in building therapeutic alliance with unaccompanied immigrant children and addressing their unique needs.