Marianne Welmers

Summary 173 APPENDICES Given the therapists’ vital role in building strong alliances, the next step in Chapter 3 was to investigate the predictive value of therapists’ personality, years of clinical experience and observed alliance building behaviors for mid-treatment alliance as reported by therapists and familymembers ( N = 57 families). Therapist openness to experience and agreeableness aswell as therapists’ in-session engagement and emotional connection behaviorspredicted more positive therapist and family member reports of the alliance. Therapist neuroticism, extraversion and conscientiousness predicted more negative alliance-reports. In-session safety behaviors also predicted more negative alliance-reports, but this finding was only significant for therapists’ and not familymembers’ reports of the alliance. Therapists’ clinical experience did not predict the quality of alliances. Chapter 4 focused on the occurrence and development of discrepancies between alliances of different familymembers, and the therapists’ evaluation of multiple alliances and discrepancies. Familymembers, therapists, andobservers reportedearly andmid-treatment alliance ( N =61 families). Thestudyshowedsignificant discrepancies, withstrongest alliances for mothers, followed by fathers, and then youths. These alliance discrepancies became smaller during treatment. Therapist-reports yielded similar discrepancies as compared to client self-reports and observer-reports. In the starting phase of treatment, the correlation between therapist- and client self-reports was moderate and significant for alliances with mothers, but non-significant for alliances with fathers and youths. Two months later, these correlations were large for alliances with mothers and fathers, but not for youths. Chapter 5 presented results of an explorative study on the association between (a 1 ) family members’ unbalanced alliances (alliance differences), (a 2 ) thewithin-family alliance or shared sense of purpose (SSP) , and (b) youth behavior problems 18 months after ending HBFT. Considering the small sample size ( N = 29 families) and limited statistical power, the study also reported trend-significant and substantial non-significant correlations that might be of theoretical importance. A greater imbalance in observed early-treatment alliances was associated with less externalizing and total youth behavior problems at follow up. Over the course of treatment this association changed to the opposite direction: at mid-treatment a greater imbalancewasassociatedwithmoreexternalizingand total youthproblems, although the association was small and not significant. One conclusion was that perhaps the process of balancing family members’ differing alliances during treatment, rather than the lack of difference in alliances itself, may contribute to improvement of children’s behavior problems. Furthermore, higher levels of mid-treatment shared sense of purpose were moderately, but not significantly associated with the decrease of youth internalizing behavior problems 18 months post-treatment. This indicates that a stronger shared sense of purpose within the family at mid-treatment may have a clinical significance in reducing internalizing child behavior problems that warrants further exploration.