Marianne Welmers

General Discussion 137 CHAPTER 6 alliance may differ notably from one family member to another, especially during the starting phase of treatment. More specifically, similar to results of some prior studies (Robbins et al., 2003; 2008), we found that therapists had stronger alliances with parents as compared to youth. This study was – to my knowledge – the first to show a significant difference between mothers and fathers: therapists had stronger alliances with mothers in the early treatment phase. However, these differences between fathers and mothers faded over the course of treatment, whereas differences in alliance between parents and youth remained. These findings indicate that building alliances with youth in the context of family treatment presents a specific challenge, deserving some further reflection. Engaging ‘Treatment Hostages’: Alliances with Children and Adolescents Several authors have vividly described challenges specific to building alliances with youth regardless of treatment context, related for instance to children’s and adolescents’ developmental stages (e.g., Cirasola et al., 2021; Karver et al., 2018; Shirk et al., 2011; Thompson et al., 2007). In family treatment, various factors add to this complexity. First, for children and adolescents, family treatment belongs to the world of adults (Escudero & Friedlander, 2017), because it can usually only be initiated by adults, and is always provided by an adult. Consequently, children and adolescents are less powerful interaction partners than adults, which makes it hard for them to ‘take the floor’ and actively participate during a conjoint session (O’Reilly, 2008). Second, treatment is oftentimes initiated as a solution to the child’s “problematic behavior”, resulting in the child feeling accused and punished by being dragged into treatment alongside their parents. Thus, children and adolescents often expect treatment to be a correcting and coercive environment, resulting in defensive and mistrusting behavior (Escudero & Friedlander, 2017). The presence of parents in sessions, even though of crucial importance, may add to this mistrusting attitude in children and adolescents, since it may cause feelings of shame or fear of negative consequences after the treatment session (Escudero & Friedlander, 2017; Strickland-Clark et al., 2000). Adding to the complexity of building alliances with youth in family treatment, Chapter 4 indicated that the therapist’s perspective on the alliance with a child or adolescent in treatment may differ largely from this child’s or adolescent’s own perspective. This finding indicates that treatment effectiveness may benefit from asking children’s and adolescents’ feedback on the alliance: asking alliance feedback was found to be effective in adult psychotherapy too (e.g., Mihalo & Valenti, 2018; Van Hennik, 2020; Zilcha-Mano & Errazuriz, 2015). However, it is important to note that ‘what works’ in building alliances with adults can be counterproductive when forming an alliance with an adolescent (Creed & Kendall, 2005). For example, addressing clients’ negative feelings towards the therapist in order to repair an alliance rupture appeared to be effective in adults (Safran et al., 1994),