Objective: Young peoples mental health problems have increased in recent decades, leading to a growing demand for psychosocial support within Child and Adolescent Psychiatry (BUP). The aim of this study is to explore how counselors within BUP understand and work with the therapeutic alliance when treating youths experiencing mental health issues. 

Methods: The study uses semi-structured interviews with eight participants who included counselors and psychotherapists from two BUP clinics. The material was analysed using thematic analysis to identify recurring patterns in how building alliances is understood and enacted in practice.

Results: The analysis shows that counselors building the therapeutic alliance through genuineness, emotional response and clear structures creates safety for young people. Participation in goal setting strengthens motivation, while continuous adaptation to each individuals needs is essential. Signs of a weakened alliance through avoidance or reduced engagement, require active relational repair to maintain treatment progress.

Conclusion: The study confirms that the therapeutic alliance is central for engaging young people in treatment. Counselors often carry the initial relational responsibility, especially when youths have experienced instability, making relational competence and flexible adaptation essential in BUP practice.