Marianne Welmers

Appendices 174 Conclusions Study findings presented in this dissertation underline both the importance and complexity of building strong working alliances with families receiving (home-based) treatment for complex child and parenting problems. Taken together, findings also underscore the relevance of a systemic perspective on the working alliance in (home- based) family treatment both in research and clinical practice. This systemic perspective includes addressing the process of building multiple interacting alliances with different family members, engaging children and adolescents in a conjoint treatment process with parents, and promoting the family’s collaboration on shared goals. Important next steps in research on alliance in family treatment include studying larger andmore diverse samples to provide a stronger evidence base, enhance generalizability, and enable more sophisticated methods to study the effect of systemic alliance aspects on treatment outcome. Furthermore, research on the process of alliance aspects typical of systemic family treatment could benefit from a qualitative multi-informant approach (e.g. the use of Stimulated Recall Interviews), for example to investigate therapists’ contributions to alliances with youth in conjoint treatment sessions and the occurrence and repair of problematic disbalances in family members’ alliances. Finally, applying a more integrative research approach including multiple process factors as well as early treatment gain measures may enhance our understanding of how and when which key factors in the treatment process should be addressed to promote positive outcomes of home-based family treatment. Clinical practice as well as training and education of (future) providers of family treatment may benefit from addressing the working alliance by focusing on therapists’ alliance building behaviors, for example by the use of video feedback, and from attending to the influence of personality traits on building alliances with the family. Findings in this dissertation indicate that in every-day practice, the importance of systemic alliance aspects such as promoting family members’ collaboration on shared goals is often overlooked. However, systemic awareness and skills in building multiple interacting alliances both with and within the family is likely to increase effectiveness of (home- based) family treatment, serving the interests of families who rely on this key service to overcome complex child and parenting problems.