Marianne Welmers

Chapter 1 16 Results presented in this dissertation should provide tools for building, monitoring, and strengthening allianceswith families in systemic (home-based) family treatment, aswell as for enhancing training and supervision of (future) providers of systemic family treatment. These tools may help in optimizing the complex everyday practice of home-based family treatment serving families with severe child and parenting problems. Moreover, increased knowledge on how alliance processes may contribute to desirable treatment outcomes, may serve a wide range of youth and family care professionals, regardless of specific target problems or applied models and approaches (Barth et al., 2012). Outline of the Dissertation As a first step towards a better understanding of the importance of the alliance in family- involved treatment, Chapter 2 presents results of a meta-analytic review on the alliance- outcome association in family-involved treatment for youth problems. In this review, including 28 studies ( N = 2126 families), three multi-level meta analyses examined the effect of the quality of the alliance, alliance improvement over the course of treatment, and unbalanced or split alliances within the family on treatment outcome. I also examined the moderating effect of several methodological, treatment, and sample characteristics to investigate whether the alliance may be extra important under certain conditions or for specific groups. Subsequently, Chapters 3, 4, and 5 present empirical studies investigating the process of alliances during treatment (Chapters 3 and 4), and the association between systemic aspects of the alliance and outcome (Chapter 5). Given the vital role of the therapist in building strong alliances, Chapter 3 presents a study on therapists’ contributions to the alliance. In a sample of 57 families receiving IPT provided by 33 therapists, the contribution of therapists’ personality traits, years of clinical experience, and observed in-session alliance building behaviors to family members’ and therapists’ mid-treatment reports of the alliance was examined. Chapter 4 presents results of a study on the occurrence and development of alliance discrepancies between family members and the therapists’ perspective. In this study, observer-, therapist-, and family members’ self-reported alliances of 61 families receiving IPT were analyzed. To investigate alliance discrepancies, the strength of alliances with the therapist between family members were compared. I also compared different perspectives (i.e. therapist, client, observer) on alliance discrepancies and investigated whether congruence between the therapist- and the family member’s self-report of the alliance differed between family members. The final empirical study, presented in Chapter 5, aimed at identifying the importance of systemic alliance aspects in enhancing long-term treatment outcome in a sample of 29