Marianne Welmers

Chapter 6 134 families of younger adolescent children. Findings also underscore the importance of a process-oriented approach when investigating alliances, with multiple measurement moments over the course of treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families. Given the therapists’ vital role in building strong alliances, in Chapter 3 I investigated the predictive value of therapists’ personality, years of clinical experience and observed alliance building behaviors for mid-treatment alliance as reported by therapists and family members. Participants were 77 parents and 21 youth from 57 families receiving HBFT from 33 therapists. Therapist openness to experience and agreeableness as well as therapists’ in-session engagement and emotional connection behaviors predicted more positive therapist and family member reports of the alliance. Therapist neuroticism, extraversion and conscientiousness predictedmore negative alliance-reports. In-session safety behaviors also predicted more negative alliance-reports, but this finding was only significant for therapists’ and not family members’ reports of the alliance. Therapists’ clinical experience did not predict the quality of alliances. Chapter 4 focused on the occurrence and development of discrepancies between alliances of different family members, and the therapists’ evaluation of multiple alliances and discrepancies. Participants were 92 parents and 61 youths from61 families receiving HBFT. Family members, therapists, and observers reported early and mid-treatment alliance. There were significant discrepancies, with strongest alliances for mothers, followed by fathers, and then youths. These alliance discrepancies became smaller during treatment. Therapist-reports yielded similar discrepancies as compared to client self-reports and observer-reports. In the starting phase of treatment, the correlation between therapist- and client self-reports was moderate and significant for alliances with mothers, but non-significant for alliances with fathers and youths. Two months later, these correlations were large for alliances with mothers and fathers, but not for youths. Chapter 5 presented results of an explorative study on the association between (a) family members’ unbalanced alliances (alliance differences) and the within-family alliance or shared sense of purpose (SSP) , and (b) youth behavior problems 18 months after ending HBFT. For this study, families were included in the sample if they provided data on a measure of the alliance with the therapist for at least two family members, or if they provided data on ameasure of the within-family alliance. In addition, families had to report data on the measures of youth behavior problems at the start as well as 18 months post- treatment. This resulted in a sample of 29 families. Considering the small sample size and limited statistical power, we also reported trend-significant and substantial non-significant