Marianne Welmers

General Introduction 13 CHAPTER 1 Investigating Alliances in Systemic Family Treatment In systemic family treatment programs like HBFT, building strong alliances with families is complex for several reasons. First, the therapist faces the task of building andmaintaining multiple alliances with family members who differ in their developmental stages, motivation, and aims and needs in treatment. These differences between familymembers may easily result in unbalanced or split alliances, that is: alliances notably differing in strength from one family member to another (Friedlander et al., 2006a; Kindsvatter & Lara, 2012; Robbins, 2003). To complicate matters further, these multiple alliances are interacting and interdependent, as family members observe and influence each other during treatment. Building a strong alliance with one family member, may negatively impact the alliance with another family member, for example when these two family members are in continuous conflict (Friedlander et al., 2006a; Kindsvatter & Lara, 2012). Furthermore, the presence of other family members may lead to feelings of unsafety and may impact a person’s willingness to open up and co-operate during treatment sessions (Friedlander et al., 2006a; Escudero & Friedlander, 2017). After all, when the session has ended, family members continue to interact with each other, and what is said during a treatment session may have repercussions afterwards. A final complexity in systemic family treatment is that defining treatment goals and tasks is not an agreement between a therapist and one individual client, but rather a complex interactional contract between multiple individuals. In this complex interplay, collaboration of family members on shared goals seems of vital importance (Escudero et al., 2008; Friedlander et al., 2008; Isserlin & Couturier, 2012; Sotero et al., 2018). In summary, the working alliance in family treatment is not defined by the interactions and relationship between two individuals (i.e., client and therapist), but comprises a complex therapeutic systemwithmultiple interacting relationships. Thus, systemic aspects of the alliance, such as a balance between multiple family members’ alliances, their sense of safety in treatment, and their collaboration on shared goals, may play an important role in enhancing treatment outcome through the alliance (Escudero & Friedlander, 2017; Friedlander et al., 2006a; Kindsvatter &Lara, 2012; Pinsof &Catherall, 1986). Consequently, when investigating the alliance in family treatment, applying an approach that reflects this systemic complexity seems vital. However, an important deficit in systemic treatment research is that studies often investigate one individual perspective (e.g. the parent’s perspective) rather than the family perspective (Vilaça & Relvas, 2014). This also applies to the handful of studies on alliance in HBFT so far, where alliance is often investigated fromone individual perspective. As a result, little is known about the process and effect of systemic aspects of the alliance, such as the occurrence and development of unbalanced alliances or the within-family alliance.