Marianne Welmers

A Systemic Perspective on Alliances and their Relation to Outcome 111 CHAPTER 5 Introduction Home-based family treatment (HBFT) is a key service provided to families dealing with problematic child behavior and parenting problems, oftentimes at risk for a child’s out- of-home-placement. HBFT includes both ‘name-brand’ services (e.g., Home Builders, Multidimensional Family Treatment) andmoregenericHBFT services, but the commonality is that they aim at promoting parental competencies and family functioning, and thereby optimizing children’s development and the family’s self-reliance (Jordan et al., 2001; Lee et al., 2014). HBFT is typically characterized by a systemic and eclectic approach, and serves a highly heterogeneous sample of families. During the last decades, the number of families receiving HBFT has increased notably, and nowadays it is the most provided service to families in youth care (CBS, 2020; De Greef et al., 2018b; Veerman, Janssens, & Delicat, 2005; Yorgason, 2005). Thismay not be surprising, given the potential advantages of the family’s home as a treatment context (Slesnick, & Prestopnick, 2008; Waisbrod, 2012). Indeed, HBFT has been found to be effective in the treatment of youth behavior problems (Barth et al., 2007; De Greef et al., 2018b; Lay et al., 2001; Yorgason et al., 2005), multi-problem families (Bachler et al., 2016; Veerman, & De Meyer, 2015; Veerman, Janssens, & Delicat, 2005), and mothers suffering from depression (Beeber et al., 2004). In order to optimize HBFT services, it is important to know what components or factors of treatment cause positive outcomes. Surprisingly however, generic HBFT services have undergone relatively little empirical research (De Greef et al., 2018b). One factor that may play an important role in HBFT is the therapeutic or working alliance. This pantheoretical concept refers to the therapeutic relationship between therapist and client, consisting of an emotional bond and agreement on what should be the central goals and tasks of treatment (Bordin, 1979; Elvins, & Green, 2008). Therapeutic alliance has been shown to predict treatment outcome in adult-, youth-, and family-therapy (Flückiger et al., 2018; Friedlander et al., 2018; Murphy, & Hutton, 2018; Welmers – van de Poll et al., 2018). For HBFT, a handful of studies support the predictive value of the alliance for post-treatment decreases in youth behavioral problems and youth andparent symptomdistress (Johnson et al., 2006; Johnson, Wright, & Ketring, 2002), improved parent or family functioning (De Greef et al., 2018b; Johnson et al., 2006) or more general evaluations of treatment success (Bachler et al., 2016; De Greef et al., 2018b). Although providing valuable evidence for the importance of building strong alliances with families, most studies on the alliance-outcome association in HBFT in general do not account for the systemic complexity of building alliances, which is inherent to systemic treatment formats such as HBFT. In systemic family treatment, the therapist faces the complex task of simultaneously buildingmultiple alliances with different family members.