Marianne Welmers

Alliance and Treatment Outcome 61 CHAPTER 2 association between alliance and treatment outcome was stronger when youth in treatment were in their early adolescence compared to late adolescence, when clients in the study sample were help-seeking or recruited for the study instead of mandated for treatment, and when alliance measures of several time points during treatment were averaged or added. Results of our study furthermore indicate that growth of alliance during the treatment process might be a stronger predictor of treatment outcome than alliance measured at a single time point or an average of alliance measures over time. The occurrence of split alliances did not predict treatment outcome. However, only few studies reported on the association between split alliances and outcome and most studies lack a clear definition and appropriate methodology to measure split alliances. Our study underlines the importance for therapists to build strong individual alliances with all familymembers involved in treatment as well as to pay attention to systemic aspects of the alliance, such as the within-family alliance, when delivering family-involved treatment for youth problems. Furthermore, our study implicates that training and supervision of (family) therapists should not solely focus on specific treatment model techniques, but also on alliance building techniques in the context of working with multiple family members. Building these multiple alliances remains important throughout the treatment process, regardless of the treatment model. Therapists might enhance treatment outcome by monitoring individual as well as within-family alliances, in order to intervene when alliances are problematic. Future research should focus on the association between alliance and outcome in specific treatment contexts of family-involved treatment, such as homebased interventions and therapy with involuntary clients. Furthermore, future research could benefit from investigating complex aspects of alliance within family-involved treatment, such as the role of within-family alliance, the occurrence of split alliances and alliance ruptures, to gain fuller understanding of the dynamic role of alliance in family-involved treatment in order to enhance positive treatment outcome.