Marianne Welmers

Alliance and Treatment Outcome 21 CHAPTER 2 Introduction In the treatment of mental health or behavior problems of children and adolescents, involving the family can be an important part of the intervention. Given the influence of family functioning on child and adolescent development (Rutter, 2002), treatment to target problematic family functioning and to enhance protective family factors can be vital in reducing youth psychopathology. Indeed, results of several randomized controlled trials support the effectiveness of family-based treatment models for youth problems, such as Attachment Based Family Therapy (ABFT; Diamond et al., 2010), Multidimensional Family Therapy (MDFT; Henderson, Dakof, Greenbaum, &Liddle, 2010; Rigter et al., 2013), Functional Family Therapy (FFT; Hartnett, Carr, &Sexton, 2016; Sexton&Turner, 2011) andFamilyBased Therapy (FBT; Couturier, Kimber, &Szatmari, 2013; Lock, LeGrange&Agras, 2010). Moreover, incomparativemeta-analytic reviewson theeffectivenessof treatment for youthdelinquency (Latimer, 2001), adolescent substance abuse (Tanner-Smith, Wilson, & Lipsey, 2013) and anorexianervosa (Lock, LeGrange, &Agras, 2010), family treatmentmodelshavebeenshown to be more effective than interventions for youth only. Over the past years, delivery of family-based interventions for youth has become more integrative and flexible, and interventions that combine individual therapy, family treatment andsometimesmedicationhavebecome increasinglypopular (Diamond&Josephson, 2005). Anexampleof suchan integrative intervention isFamily-BasedCognitive-Behavioral Therapy (FBCBT), whichhas shown tobeefficacious for treatment of pediatricobsessive-compulsive disorder (O’Leary, Barrett, & Fjermestad, 2009; Storch et al., 2007) and anxiety disorders (Ginsburg & Schlossberg, 2002; Kendall, Hudson, Flannery-Schroeder, & Suveg, 2008). In order to gain better understanding of the effectiveness of family-involved interventions, it is important to knowwhat components or conditions of treatment cause positive outcomes. Previous research has shown that the alliance between therapists and clients is a significant predictor of treatment outcome in individual youth psychotherapy as well as family therapy (Friedlander, Escudero, Heatherington, & Diamond, 2011; McLeod, 2011; Shirk, Karver, & Brown, 2011). Most research on alliance is based on Bordin’s (1979) definition of the alliance which he developed for the individual therapy context, also referred to as therapeutic or working alliance. Bordin argues that the professional relationship between a therapist and client consists of three components: (a) an emotional bond between therapist and client based on mutual trust and sympathy, (b) agreement onwhich problems and goals are the central issue in therapy and (c) agreement on tasks that need to be performed by therapist and client in order to achieve central goals.