Marianne Welmers

Appendices 172 Background Home-based family treatment (HBFT) is the most provided service in youth care, serving a heterogeneous group of families with complex child and parenting problems. Given the fact that empirical evidence indicates varying outcomes of HBFT, it is important to examine factors that may contribute to desirable outcomes. The current dissertation aimed at investigating such an important factor: the working alliance. The central dissertation aim was 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 as well as within the family by system. To meet the central research aim, I performed a meta- analytic reviewof previous studies on the alliance-outcome association in family-involved treatment for youth problems, and collected longitudinal multi-informant questionnaire and observational data on alliances and treatment outcome in a Dutch HBFT for youth problems (Intensieve Pedagogische Thuishulp, IPT). Results To gain a better understanding of the importance of the alliance in family-involved treatment, Chapter 2 presents a meta-analytical review of 28 studies reporting on the alliance-outcome association ( N = 2126 families). The quality of the alliance was significantly associated with more positive treatment outcomes in terms of youth symptomseverity or functioning, parental or family functioning, retention, goal attainment or therapeutic progress. Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help- seeking rather than receivingmandated care, andwhen studies included younger children. The association between alliance improvement and treatment outcome was somewhat larger but just failed to reach significance, and there was no significant association between familymembers’ unbalanced or split alliances and treatment outcome. However, this may be due to the relatively small number of included studies reporting on alliance change scores or split alliances. Findings demonstrate that alliance plays a significant role in the effectiveness of family-involved treatment, especially in non-mandated care and with families of younger adolescent children. It also underlines the importance of a process-oriented approach to the alliance with multiple measurement moments during treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.