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

Abstract

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.

Mapping the progress of the process: Codevelopment of the therapeutic alliance with maltreated adolescents.

“…The present study was the first evaluation of AET, which we adapted from AEFT (Escudero et al, 2021) for circumstances in which a maltreated adolescent has no available parental figure who can take part in conjoint therapy. Like AEFT, the aim of AET is to empower client change by fostering a trusting and caring therapeutic relationship in the context of a safe and compassionate treatment environment.…”

“…The present study was the first evaluation of AET, which we adapted from AEFT (Escudero et al, 2021) for circumstances in which a maltreated adolescent has no available parental figure who This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

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

“…Therapy ended when the individual and family goals were judged to have been achieved (71.8% of families), the family dropped out of treatment (10.9%), and the child was transferred to a residential facility at another location (5.8%) or referred elsewhere for special needs treatment (8.3%). In a recent evaluation of the effectiveness of AEFT with this sample (Escudero et al, 2021), results showed significant changes in youth functioning and family-specific goal attainment, as summarized below.…”

“…AEFT was developed and evaluated (Escudero et al, 2021) as a team intervention. While the primary therapist interacts with the family, up to five members of an observing team view the session on closed-circuit TV or one-way mirror.…”

“…As reported in the previous AEFT effectiveness study (Escudero et al, 2021), we used two measures of outcome: (a) the 100-point Children's Global Assessment Scale (CGAS; Shaffer et al, 1983), which was adapted for youth from the adult Global Assessment Scale (Axis 5 in the DSM III-R; American Psychiatric Association, 1987); and (b) a 4-point modification of the Global Attainment Scale (GAS; Kiresuk & Sherman, 1968). Significant posttreatment improvement in youth functioning was found on the CGAS, p = .000, d = 1.12, with a Reliable Change Index (Jacobson et al, 1984) = 2.81 (p < .05) and mean scores (66.06; SD = 16.63), that approached the cutoff (70) for healthy child functioning (Dyrborg et al, 2000).…”