The concept of therapeutic alliance is examined in relation to treatment outcomes in youth psychotherapy. The first section of the article develops an intuitive account wherein the relationship between the therapist and youth client is purported to hold great significance for treatment effectiveness in psychological interventions. The remainder of the article aims to validate this deep-rooted intuition via close examination of how therapeutic alliance has been defined, measured, and meta-analyzed in the current literature. Methodological and philosophical challenges to the concept and implications for future research and practice are discussed. Cautious, but optimistic conclusions are drawn affirming the intuitive position that the relationship between therapist and youth client does indeed impact treatment outcome.