Marianne Welmers

Chapter 6 140 In Chapter 5, the explorative study showed a moderate association between mid- treatment SSP and more positive treatment outcomes at follow-up in terms of youth internalizing problems, although this association failed to reach significance. However, based on the small sample size resulting in limited statistical power, one conclusion in this study was that promoting the family’s shared purpose may have a clinical significance in reducing child internalizing problems that warrants further research with larger study samples. It is important to note here that only observed SSP was included in line with previous studies (Escudero et al., 2008; Friedlander et al., 2008; Isserlin & Couturier, 2012; Sotero et al., 2018). Although observations do shed light on the behavioral indicators of familymembers’ agreement and active collaboration during a treatment session¸ they do not capture familymembers’ personal experience of being aligned as a family in relation to treatment. This process of alignment and collaboration on shared goals within the family may par excellence be a process that takes place between rather than within treatment sessions. Thus, self-report questionnaires on SSP for all family members, preferably with repeated measures over the course of treatment, may help increase our understanding of this understudied concept and its relation to treatment outcome. Building Strong Alliances: The Key Role of the Therapist Following previous studies indicating the key role of the therapist in building alliances (Baldwin et al. 2007; Dinger et al., 2008; Nissen-Lie et al., 2010), a specific aim of this dissertation was to shed more light on therapists’ contributions to alliances in systemic family treatment, with several prominent findings. First, the study inChapter 3 showed that therapists’ observed alliance building behaviors significantly affected family members’ and therapists’ perceptions of the alliance, underlining the importance of actively engaging family members in the therapeutic process as well as connecting with them at an emotional level. This finding adds to the scarce body of knowledge on therapist contributions to the alliance in family treatment (Escudero et al., 2012; Friedlander et al., 2014), although one particular finding in Chapter 3 contrasts these previous studies: when therapists were observed to invest more in family members’ sense of safety in the therapeutic context, they rated alliances as less strong immediately after the session. As reasoned in Chapter 3, perhaps when therapists perceive their alliance with family members as less favorable, they increase their investment in family members’ sense of safety. Furthermore, the current dissertation was – to my knowledge – the first to show an associationbetween therapist personalityand familymembers’ and therapists’ evaluations of alliance. Findings indicate that alliances are relatively stronger when therapists report themselves to be more agreeable, open to new experiences, and emotionally stable, whereas therapists with high levels of extraversion or conscientiousness had relatively