Marianne Welmers

General Discussion 133 CHAPTER 6 General Discussion Home-based family treatment (HBFT) is the most provided service in youth care, serving a heterogeneous group of families with complex child- and parenting problems. Given the fact that empirical evidence indicates varying outcomes of HBFT, it is important to examine factors that may contribute to desirable outcomes. The current dissertation aimed at investigating such an important factor: the working alliance. The central aimwas to investigate alliance processes in (home-based) family treatment and their relation to treatment outcome, paying particular attention to the therapists’ role and to the systemic complexity of building multiple interacting alliances with and within the family. To meet the central research aim, we performed a meta-analytic review of previous studies on the alliance-outcome association in family-involved treatment for youth problems, and collected longitudinal multi-informant questionnaire and observational data on alliances and treatment outcome in a Dutch home-based family treatment for youth problems (Intensieve Pedagogische Thuishulp, IPT; Van der Steege, 2007). In this concluding chapter I provide a summary of and reflection on the main findings presented in this dissertation. Building on the presented findings, I discuss the dissertation’s strengths and limitations, and provide suggestions for future research. The chapter concludes with implications for clinical practice, education, and policy making. Summary of Main Findings To gain a better understanding of the importance of the alliance in family-involved treatment, in Chapter 2 I meta-analytically reviewed results of 28 studies reporting on the alliance-outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems ( N = 2126 families). The quality of the alliance was significantly associated with more positive treatment outcomes in terms of youth symptom severity or functioning, parental or family functioning, retention, goal attainment or therapeutic progress ( r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care, and when studies included younger children. The association between alliance improvement and treatment outcome just failed to reach significance ( r = .281, p = .067), and there was no significant association between family members’ unbalanced or split alliances and treatment outcome ( r = .106, p = .343). However, it should be noted that there was only a relatively small number of included studies reporting on alliance change scores or split alliances. Findings in this chapter demonstrate that alliance plays a significant role in the effectiveness of family-involved treatment, especially in non-mandated care and with