Marianne Welmers

Chapter 5 112 These family members often differ largely in their treatment aims and motivation, and problematic communication patterns may hinder the within-family collaboration on shared goals (Kindsvatter & Lara 2012; Friedlander et al., 2006). Given this systemic complexity, family members’ individual alliances with the therapist may not tell the whole story when investigating the alliance as a common factor in family treatment. A recent meta-analysis on the alliance outcome association in couple and family therapy indicates that systemic aspects of the alliance more strongly predict outcome than any family member’s individual alliance with the therapist, even when multiple individual alliances are averaged to measure a family’s alliance (Friedlander et al., 2018). These systemicaspects includeabalance instrengthofmultiplealliancesamong familymembers and the quality of the within-family alliance. This finding underlines the importance of a systemic approach when investigating the alliance in home-based family treatment. Consequently, in the present study we aim to investigate the association between two systemic aspects of the alliance typical of systemic family treatment and outcome in HBFT for youth problems: unbalanced alliances and shared sense of purpose (SSP). Unbalanced Alliances The first systemic aspect central in this study concerns unbalanced alliances within the family. In conjoint family treatment differences between family members in their characters, motivation, needs and expectations of the treatment and the therapist may easily result in alliances notably differing fromone familymember to another (Kindsvatter & Lara, 2012; Welmers-van de Poll et al., 2020). Moreover, family conflicts often encroach family members’ opinions on the need and aim for treatment, increasing the risk for the therapist to unintentionally ‘take sides’ and consequently causing or increasing a disbalance in alliances with different family members. This phenomenon of notable differences between family members in their alliance with the therapist is generally referred to as unbalanced or split alliances (Friedlander et al., 2006; Pinsof, & Catherall, 1986; Robbins et al., 2003). Studies on split alliances generally refer to a split when two family members’ alliances with the therapist differ at least one standard deviation (e.g. Muñiz de la Peña et al., 2009). Other studies apply a more continuous approach by investigating unbalanced alliances as the degree of difference or congruence between family members in their alliance with the therapist (e.g. Robbins et al., 2003). Although modest imbalances in alliances are thought to be common in family therapy, a handful of studies indicate that a greater imbalance in alliances increases the risk of treatment dropout (Flicker et al., 2008; Muñiz de la Peña, Friedlander, & Escudero, 2009; Robbins et al., 2003, Robbins et al., 2008). Thus, a sufficient balance in multiple alliances with different familymembers seems important for retaining families in treatment, andmay