Marianne Welmers

Chapter 1 14 One specific knowledge gap regarding alliance processes in systemic family treatment is the effect of therapist characteristics and behaviors on alliances with family members. Prior research in adult psychotherapy convincingly underlines the key role of the therapist in building strong alliances (e.g., Baldwin et al., 2007; Dinger et al., 2008; Nissen-Lie et al., 2010), and indicates that therapists differ substantially in how much they succeed in building alliances with their clients (Dinger et al., 2008; Nissen-Lie et al., 2010). Thus, investigating therapist characteristics and behaviors that contribute to better alliances may increase our understanding of between-therapist differences in treatment effectiveness. However, the specific role of the therapist in building alliances in family treatment seems largely understudied (Sotero et al., 2017). Given the complex systemic nature of building alliances in family treatment, more knowledge on therapists’ contributions to the alliance seems essential in optimizing training and supervision of (future) providers of systemic family treatment. Alliance as a Dynamic Process: The Added Value of Observational Research When investigating the alliance, it is important to realize that alliance is a dynamic process that evolves over time. This process unfolds both intrapersonally (within therapists’ and clients’ thoughts and feelings) as well as interpersonally (within the therapist – client interactions; Horvath, 2006). Most studies on alliance in youth and family treatment focus on the intrapersonal aspect by using alliance questionnaires (Barnhoorn et al., 2013). Although providing valuable insight into therapists’ and clients’ alliance perceptions, the use of questionnaires fails to do justice to the behavioral and interactional nature of the alliance. This behavioral, interpersonal aspect of alliance is typically addressed by using observations of therapists’ and clients’ in-session behaviors and interactions. An important benefit of observational process research is that it provides data that most closely reflect real-world phenomena. Thus, combining questionnaires with observational data can be of great added value in connecting research to practice (Oka &Whiting, 2013). There are several observation instruments available to investigate the alliance, most of them designed for the context of individual therapy (Friedlander et al., 2019). A unique instrument specifically designed for the context of conjoint family treatment, is the System for Observing Family Therapy Alliances – observer version (SOFTA-o; Friedlander et al., 2006a). Two individual alliance domains of the model reflect Bordin’s (1979) definition of the working alliance: Engagement in the Therapeutic Process, referring to goal and task elements of the alliance, and Emotional Connection to the Therapist, referring to bond elements of the alliance. The other two SOFTA domains concern systemic aspects of