INTRODUCTION
Research indicates that only about 25% of adolescents with mental health problems have been in touch with mental health care the past year. Many young clients come to therapy at the initiative of others, meeting mental health care at a less-than-optimal starting point considering the importance for adolescents to assert agency in therapy. Moreover, 28–75% of young clients quit treatment prematurely. Their reasons are diverse: Some are dissatisfied, some perceive (whether or not the therapist concurs) that they have achieved what they wanted, and some quit because of difficulties outside therapy. In-session events and therapist behaviors are linked to adolescents dropping out of treatmen, but it has been difficult to predict which young people are at risk of dropping out. Taken together, research indicates that the existing clinical practice in mental health care does not succeed in providing treatment that is perceived as accessible or helpful for many adolescents (Kessler et al. 1995). Therefore, to improve services, it is important to understand what differentiates helpful from unhelpful treatment from the perspective of adolescents, especially when therapy has a difficult starting point, e.g., when adolescents enter mental health care at the initiative of others.