Marianne Welmers

Chapter 2 26 Furthermore, sample characteristics canmoderate the association between alliance and outcome. In three meta-analytic reviews on alliance in youth psychotherapy it has been shown that the nature of patients’ problems was a moderating factor: in two reviews, alliance correlated more strongly to outcome for youth with externalizing problem behavior than for youth with internalizing problems (McLeod, 2011; Shirk & Karver, 2003). A third review indicated that for youth dealing with substance abuse and mixed problems alliance correlated more strongly to treatment outcome than for youth dealing with eating disorders (Shirk, Karver, & Brown, 2011). In two of thesemeta-analytic reviews, age of youth also proved to have amoderating effect, with stronger correlations between alliance and outcome for younger children compared to adolescents (McLeod, 2011; Shirk & Karver, 2003). Another moderating sample characteristic is shown in a study on alliance and outcome in home-based family therapy, where a stronger correlation between alliance and outcome was found for fathers than for mothers (Johnson et al., 2002). This suggests that gender can moderate the effect of alliance on outcome. Lastly, it can be reasoned that cultural differences play a role in how important the alliance is in enhancing favorable treatment outcomes, especially in family-involved treatment. For example, in more collectivist cultures the within-family alliance or the extent to which alliances with multiple family members are unbalanced might be of more influence on treatment outcome compared to more individualist cultures. This is illustrated in a study on ethnic background, therapeutic alliance and retention in Functional Family Therapy (FFT), in which unbalanced alliances between family members predicted treatment dropout for Hispanic American families, but not for Anglo-American families (Flicker et al., 2008). Present study To date, nometa-analytic review of alliance and outcome in family-involved treatment for youth problems has been published that also focused on moderators of the association between alliance and outcome and included studies published since 2008. The present studymeta-analytically summarizes research findings on alliance and treatment outcome in family-involved treatment for youth problems over the past three decades. The purpose is to provide accurate estimates of the associations between the level of alliance and treatment outcome, alliance change scores and treatment outcome, and split alliances and treatment outcome, paying particular attention to both within and between study variability by performingmoderator analyses in a multi-level meta-analysis. The analyses therefore ensure maximum use of the available data and provide valuable insight into the process of building, maintaining and measuring alliance in order to enhance positive outcome in family-involved treatment for youth problems.