Marianne Welmers

A Systemic Perspective on Alliances and their Relation to Outcome 129 CHAPTER 5 more effective methods to investigate the effect of unbalanced alliance on treatment outcome (e.g., polynomial regression, or the use of a latent group model; Bartle-Haring et al., 2012; Kivlighan, 2007). Our study findings suggest that it may be particularly interesting to investigate the effect of processes in the family’s shared sense of purpose and alliance differences over the course of treatment (e.g., improving versus impairing shared purpose). Second, a more qualitative observational investigation on unbalanced alliances may improve our understanding of how and when differences between family members’ alliances with the therapist become problematic. Furthermore, investigating predictors of the family’s shared purpose and alliance differences may increase our understanding of how these systemic aspects of the alliance can be affected in order to enhance treatment outcome. Finally, future research on the effect of shared purpose and unbalanced alliances may benefit from investigating a broader range of treatment outcomes, including end-of-treatment measures and measures of improvement on therapeutic goals and of youth and family functioning. Conclusions Establishing the degree to which systemic aspects of the alliance matter for positive outcomes of home-based family treatment seems important; this study was – to our knowledge – the first to examine the alliance froma systemic perspective in the context of home-based family treatment, and has thus taken a first step toward that goal. Our findings suggest clinical significance of unbalanced alliances and of the within-family alliance or shared sense of purpose that warrant further exploration. Ongoing research should examine the effect of the interaction between multiple family members’ alliances and of the family’s shared sense of purpose, their courses over treatment, and their predictors, to allow for further understanding of the complex role of alliance in (home-based) family treatment. This may help providers of HBFT in establishing strong therapeutic alliances bothwith andwithin the family system to facilitatemeaningful changes for families dealing with a variety of youth and family problems.