Alliance discrepancies in home‐based family treatment: occurrence, development and the therapist’s perspective

Poll, Marianne J. Welmers-van de; Stams, Geert-Jan; Akker, Alithe L. van den; Overbeek, Geertjan

doi:10.1111/1467-6427.12309

Cited by 6 publications

(9 citation statements)

References 43 publications

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“…Second, like Welmers-van de Poll et al (2020), we examined the alliance from all three perspectives. However, unlike that study and many other FT studies that used an alliance measure originally developed for individual psychotherapy, we used the SOFTA-s (Friedlander et al, 2006), which asks therapists to report on their alliance with the family unit and clients to report on their personal experience of the alliance and the perceived experiences of other family members, including within-family collaboration.…”

Section: Discussionmentioning

confidence: 99%

“…Over several decades, an increasing number of naturalistic studies conducted in community agencies (e.g., Escudero et al, 2008;Friedlander et al, 2008) and families' homes (e.g., Bachler et al, 2016;Johnson et al, 2002;Welmers-van de Poll et al, 2020) provided valuable information about how meaningful change can take place in family therapy (FT; Heatherington et al, 2015). To contribute to knowledge in this area, we conducted a processoutcome study with maltreated youth and their caregivers focusing on the therapeutic alliance, which has repeatedly been associated with outcome in couple and FT, meta-analytic r = .248, p < .001 (Friedlander et al, 2018).…”

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confidence: 99%

“…Despite the critical importance of doing so, we located few investigations in which therapists’ alliance perceptions were compared to those of family members. Welmers-van de Poll et al (2020), for example, found that therapists tended to report stronger, more congruent alliances with parents, particularly mothers, than with adolescents. This study did not, however, assess alliance development over time or associations between congruent perspectives on the alliance and treatment outcomes.…”

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confidence: 99%

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Family therapy for maltreated youth: Can a strengthening therapeutic alliance empower change?

Escudero¹,

Friedlander²,

Kivlighan³

et al. 2023

Journal of Counseling Psychology

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We tested the process of change in Alliance Empowerment Family Therapy (AEFT; Escudero, 2013), a systemic, team-based approach for treating child welfare involved families. Since building and balancing strong personal and within-family therapeutic alliances are crucial for motivating and sustaining change in these multistressed, overburdened families, we assessed alliance perceptions over time in relation to two indices of therapy outcome, youth functioning, and family-specific goal attainment. Specifically, we administered the self-report version of the System for Observing Family Therapy Alliances (Friedlander et al., 2006) following Sessions 3, 6, and 9 to 156 Spanish families seen by 20 therapists in six agencies whose mission is to serve child welfare referred maltreated youth. Results showed that AEFT delivered in M = 11.04 sessions (SD = 3.29) was effective in attaining family-specific goals and improving child functioning, d = 1.16, as rated by the therapist team in coordination with the referring caseworker. A unique aspect of the study was the modeling, at each time point, of the shared therapeutic system alliance, a latent variable consisting of the therapist's rating of the alliance as well as the alliance ratings of the youth and primary caregiver. As we hypothesized, shared alliance perceptions strengthened with time and positively predicted posttreatment outcomes. Moreover, a comparison of linear growth models with and without the therapist's perspective showed that inclusion of the therapist ratings in the shared alliance variables improved the predictability of child and family outcomes. Public Significance StatementWe studied the process and outcomes of Alliance Empowerment Family Therapy (AEFT), a treatment specifically developed for child welfare referred families that emphasizes the therapeutic alliance as the central component of change. As we predicted, the shared alliance perceptions of youth, caregivers and therapists increased in strength over time and positively predicted improved child and family functioning.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Family therapy for maltreated youth: Can a strengthening therapeutic alliance empower change?

Escudero¹,

Friedlander²,

Kivlighan³

et al. 2023

Journal of Counseling Psychology

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“…Despite these differences, the alliance is integral to successful psychotherapy with young people and their families (Karver et al, 2018(Karver et al, , 2019McLeod, 2011;Roest et al, 2023a). However, it is argued that the alliance should be measured from a dyadic or even systemic perspective, especially in family treatment (Roest et al, 2023b;Welmers-Van de Poll et al, 2020).…”

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confidence: 99%

The psychometric properties and treatment outcomes associated with two measures of youth therapeutic alliance using naturalistic data

Mahon,

Minami,

Brown

2024

Couns and Psychother Res

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PurposeThis is the second of two articles that examine the psychometric properties and treatment outcomes associated with two measures of the therapeutic alliance in naturalistic routine settings.MethodsData were taken from the ACORN database for youth, and, where available, parent/carer, attending for psychotherapy treatment in naturalistic settings (N = 12,573). The sample, the largest to date, included only those completing both an alliance measure and an outcome measure at every session. Two sets of three different alliance items are used across the two populations in routine practice.ResultsAnalyses revealed that the alliance explained no more than 3% of the variance in outcomes. Alliance measures exhibit ceiling effects, and as such, drawing conclusions about correlations with outcomes can be difficult. Any drop in alliance score as rated by both youth and parent/carer is predictive of outcomes, with parent/carer ratings being marginally more predictive. Where the alliance is rated as better by youth or parent/carer in comparison with ratings as worse, effect sizes are up to 50% better for the youth.ConclusionThe therapeutic alliance remains an important non‐specific treatment component; however, measures of the alliance have ceiling effects. Both youth and their parent/carer can provide important feedback to the therapist, and any drop in alliance is predictive of clinically meaningful change. As such, therapists should monitor the alliance with both youth and parent/carer. Implications for practice, training and research are considered.

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“…Despite the importance of comparing the therapist's view of the alliance to those of youth and caregivers, we located one family therapy study that did so (Welmers‐van de Poll et al, 2020). Results showed that therapists’ perceptions of the alliance were less congruent with the perceptions of adolescents than with those of their parents, particularly the mothers.…”

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confidence: 99%

Toward a broader understanding of split alliances in family therapy: Adding the therapist to the mix

et al. 2021

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To broaden our understanding of a split alliance in family therapy, we investigated the frequencies and correlates of sessions in which therapists, youth, and caregivers reported markedly different perceptions of the alliance. The sample consisted of 156 Spanish families who received Alliance Empowerment Family Therapy (Escudero, Adolescentes y familias en conflicto, 2013) for child maltreatment. Family members and therapists rated the alliance on the SOFTA‐s (Friedlander et al., Journal of Counseling Psychology, 2006, 53, 214) after sessions 3, 6, and 9; family members rated their perceptions of treatment progress before sessions 4, 7, and 10. A cluster analysis differentiated sessions with a split adult‐youth alliance (27.7%) from a split family‐therapist alliance (44.1%), and a balanced alliance (similar ratings across the three perspectives; 28.2%). Client‐rated treatment progress was differentially associated with the type of alliance split and the average alliance rating, whereas better posttreatment outcomes (child functioning and family goal attainment) were associated with fewer sessions having either type of split alliance.

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Alliance discrepancies in home‐based family treatment: occurrence, development and the therapist’s perspective

Abstract: Alliance discrepancies in home-based family treatment: occurrence, development and the therapist's perspective M.J. Welmers-van de Poll , a,b G.

Cited by 6 publications

References 43 publications

Family therapy for maltreated youth: Can a strengthening therapeutic alliance empower change?

Family therapy for maltreated youth: Can a strengthening therapeutic alliance empower change?

The psychometric properties and treatment outcomes associated with two measures of youth therapeutic alliance using naturalistic data

Toward a broader understanding of split alliances in family therapy: Adding the therapist to the mix

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