Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis

Abstract

Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies. However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance–outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance–outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N = 2126 families, M age youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of the associations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r = .281, p = .067), and no significant correlation was found between split alliances and treatment outcome (r = .106, p = .343). However, the number of included studies reporting on alliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

“…The increased resistance to treatment and to change may require more time and effort to form a strong alliance with the involuntary group (Snyder & Anderson, ). Results of two recent meta‐analyses suggested that mandated status moderates the alliance‐outcome correlation for youth mandated to attend therapy (McLeod, ; Welmers‐van de Poll et al, ).…”

Alliance Between Therapist and Multi-stressed Families During the COVID-19 Pandemic: The Effect of Family-Based Videoconferencing

“…Alliance consists of the affective and collaborative aspects of a client–therapist relationship and is usually conceptualized as personal alliance (the affective bond) and task-related alliance (addressing the goals of the treatment and the tasks required to achieve those goals; Bordin, 1979 ; Hougaard, 1994 ). A strong alliance is associated with positive treatment outcomes and higher client satisfaction in a wide range of psychotherapeutic interventions, such as individual child, adolescent and adult psychotherapy, family-based or systemic therapy, and parenting interventions (de Greef et al, 2017 ; Friedlander et al, 2018 ; Karver et al, 2018 ; Welmers-van de Poll et al, 2018 ).…”

Therapists’ Contributions to the Alliance in Home-Based Family Treatment: The Role of Alliance Building Behaviors, Personality, and Clinical Experience

“…In this study we thus focused on predicting both family members' and therapists' experiences of the alliance. Because we were interested in alliance as a dynamic process that develops over time (Horvath, 2011;Welmers-van de Poll et al, 2018), we investigated mid-treatment alliance, taking into account the possible effects of early treatment therapist behavior and alliance.…”

“…Alliance is generally defined as a professional relationship between a therapist and his or her client, consisting of an emotional bond and agreement on what goals and tasks should be central during treatment (Bordin, 1979;Elvins, & Green, 2008). It has shown to be a significant contributor to psychotherapy outcome in adults, youth and families (Flückiger et al, 2018;Murphy & Hutton 2018;Welmers-van de Poll et al, 2018). However, several studies have shown that therapists differ substantially in how much they succeed in building alliances with their clients (Dinger et al, 2008;Nissen-Lie et al, 2010).…”