Therapeutic Alliance and Autism: A Scoping Review

ABSTRACT Background Autistic children and adults commonly experience co‐occurring mental health conditions. It is critical that we understand key therapeutic factors that promote positive therapy outcomes for autistic individuals. Prior research suggests that therapeutic alliance (TA) positively impacts psychotherapeutic outcomes, but most has been conducted with allistic populations. This scoping review broadly aimed to synthesise emerging research on TA for autistic individuals and identify gaps in the literature about TA for autistic individuals. Methods PRISMA scoping review guidelines were followed. A literature search conducted in January 2025 resulted in n = 15 studies meeting inclusion criteria. Studies included n = 657 autistic individuals aged 7–77 years. Results Findings supported the reliability of some standardised tools (e.g., TASC‐R , TPOCS‐A ) for measuring TA for autistic youth. No identified studies used standardised tools to assess TA for autistic adults older than 21 years of age. TA was positively associated with psychotherapeutic outcomes for autistic youth (e.g., greater reductions in anxiety symptoms) across most quantitative studies. Autistic children may be at risk for weaker TAs compared to allistic children. Some pretreatment child factors were identified that may be associated with TA (e.g., cognitive skills, emotional regulation, psychopathology) and several therapist characteristics were identified that may promote strong TAs for autistic adults based on qualitative findings (e.g., respect, autism knowledge, validation, providing structure and accommodations, self‐disclosure). Additional gaps in the literature are discussed. Conclusion TA can be reliably measured for autistic youth and appears to be connected to both pretreatment client factors and therapy outcomes, though additional work with more diverse samples is needed. Therapist behaviours and use of neuro‐affirming strategies can impact TA for autistic adults.