Marianne Welmers

General Introduction 15 CHAPTER 1 the alliance unique to conjoint family treatment. Safety within the Therapeutic System refers to familymembers experiencing the therapeutic environment as a safe place where they can take risks, be open and flexible, and handle family conflicts without risking harm. Finally, Shared Sense of Purpose within the Family refers to the within-family alliance, or a sense of unity and collaboration between family members on shared goals (Friedlander et al., 2006a). Using the SOFTA-o provides the opportunity of measuring the strength of alliances as reflected in family members’ behaviors by using the client version, as well as to measure therapists’ behavioral contributions to the alliance with the therapist version. Several studies illustrated the SOFTA-o’s reliability and validity (e.g. Friedlander et al., 2006b; Sotero et al., 2017). In prior research, the SOFTA-o has been used to study alliances in family therapy as usual (Beck et al., 2006; Escudero et al., 2008; 2012; Friedlander et al., 2008a; 2008b; 2012; 2014; Higham et al., 2012; Lambert et al., 2012; Lambert & Friedlander, 2008; Muñiz de la Peña et al., 2009; 2012), Brief Strategic Family Therapy (Sheehan & Friedlander, 2015), family therapy with involuntary referred families (Sotero et al., 2016; 2017; 2018), family-based treatment of adolescent anorexia (Isserlin &Couturier, 2012), and family psycho-education for parents of a daughter or son with a severemental illness (Levy-Frank et al., 2011). However, to my knowledge no studies have been carried out using the SOFTA-o – or any other observational measure – to study alliances in the context of home-based family treatment. Dissertation Aims and Scope The current dissertation focusses on alliances in a clinically representative context of home-based family treatment for youth problems. The central aim is to investigate alliance processes in home-based family treatment and their relation to treatment outcome, paying particular attention to the therapists’ role and to the systemic complexity of building multiple interacting alliances with and within the family. To meet these study aims, I reviewed the current body of research on alliance in relation to outcomes of family-involved treatment for youth problems, and collected longitudinal, multi-informant questionnaire and observational data with 61 families receiving a Dutch home-based family treatment programcalled Intensieve Pedagogische Thuishulp (IPT; Van der Steege, 2007). IPT serves families dealing with complex child behavior and parenting problems, often accumulated with problems in other domains (e.g., financial problems, parental psychopathology, or lack of a supporting social network). It has an empowering, systemic approach, and building a strong working alliance with the family is a key principle (Van der Steege, 2007).