Marianne Welmers

General Discussion 145 CHAPTER 6 Finally, a very small number of youth with self- and observer-reports on the alliance was included. A promising direction to further investigate children’s and adolescent’s perspectives on their alliance with the therapist in the context of systemic family treatment, is the use of video-stimulated recall interviews (SRI’s; e.g. Morgan, 2007; Van Mourik et al., 2018). SRI’s allow children and adolescents to watch their actual, video-taped interaction with the therapist and other family members during a session. Based on their own specific observations, they then may answer questions, for example, on what helps and hinders their active involvement and bonding in treatment. Therapists’ and parents’ perspectives on effectively building alliances with youth in family treatment can be investigated using the same strategy. Moreover, the use of SRI’s may be highly beneficial to research on the broader process of building alliances in systemic family treatment, for example, when investigating the occurrence of problematic unbalanced alliances and therapist behaviors either contributing to or impairing this unbalance. Practical Implications Findings presented in this dissertation translate into several recommendations to enhance (home-based) treatment of families with complex child and parenting problems. First, on the level of clinical practice, it should be noted that findings in this dissertation indicate that providers of home-based family treatment do a fairly good job in building strong alliances with individual family members (especially parents), by actively engaging them in the treatment process and connecting with them on an emotional level. This is important, as it increases the odds of positive treatment outcome, regardless of the treatment model. However, it is also important to realize that building multiple interacting alliances with the family is complex: the strength of the alliance is likely to differ between family members, building strong alliances with youth in family treatment seems particularly challenging, and promoting a shared sense of purpose within the family seems important but is often overlooked. Monitoring alliances both with and within the family may prove helpful in detecting and repairing problematic alliances as well as in balancing different family members’ alliances over the course of treatment, for example by using video-observations and asking family members’ feedback. Asking feedback on the alliance has shown to be effective in several settings (e.g., Mihalo & Valenti, 2018; Van Hennik, 2020; Zilcha-Mano & Errazuriz, 2015), and good examples of using a feedback form that is accommodated both to the systemic context of family treatment and the specific needs of youth are emerging (e.g., Rober et al., 2020; Rober, 2017).