Marianne Welmers

Chapter 4 106 Studies on the effect of congruence in therapist- and self-reported alliance have shown somewhat ambiguous results, ranging fromno effect in adult psychotherapy (Fitzpatrick, Iwakabe, & Stalikas, 2005) to better outcomes when ratings are more congruent in adult psychotherapy (Bachelor, 2013; Kivlighan, 2007; Rozmarin et al., 2008; Zilcha-Mano, Snyder, & Silberschatz, 2017) or when congruence increases during treatment in youth CBT (Fjermestad et al., 2016). However, studies on the effect of congruence between therapist and client ratings of the alliance in conjoint family treatment are sparse. In family treatment, perhaps congruence of one family member with the therapist might be more important for positive treatment outcome as compared to other family members. Our finding that therapist- and self-reports of the alliance with parents were more congruent as compared to those of youths underline the importance of this issue. Our findings underline the complexity of building and monitoring multiple alliance processes in conjoint family treatment. Our findings demonstrate that the therapist’s perspective on the alliance with a specific family member is not necessarily comparable with that family members’ own perspective, especially with youths. To gain amore shared perspective on the alliance, therapists could consider asking family members’ feedback on the alliance, which has proven to be effective in several settings (e.g. Mihalo, & Valenti, 2018; Van Hennik, 2020; Zilcha-Mano, & Errazuriz, 2015). In doing so, it is recommended to pay particular attention to children’s and adolescents’ feedback on the alliance (for an example, see Rober et al., 2020). Our findings also demonstrate that differences in alliances with the therapist between family members are the rule rather than the exception. The awareness that building alliances with some family members (most often youths) demands an extra effort might enhance the process of building and balancing multiple alliances in family treatment.