Marianne Welmers

Therapists’ Contributions to the Alliance 65 CHAPTER 3 Introduction Do some therapists have more success with their clients than others, and if so, what factors might explain this between-therapist difference? This question has received growing attention in psychotherapy research, and several studies indeed indicate substantial between-therapist variability in explaining treatment outcome (Crits-Cristoph, & Mintz, 1991; Huppert et al., 2001; Zuroff et al., 2010). Previous studies have indicated that the extent to which they succeed in building alliances might be an important factor in explaining variability in therapy success between therapists (Baldwin et al., 2007; Zuroff et al., 2010). Alliance is generally defined as a professional relationship between a therapist and his or her client, consisting of an emotional bond and agreement on what goals and tasks should be central during treatment (Bordin, 1979; Elvins, & Green, 2008). It has shown to be a significant contributor to psychotherapy outcome in adults, youth and families (Flückiger et al., 2018; Murphy, & Hutton, 2018; Welmers – van de Poll et al., 2018). However, several studies have shown that therapists differ substantially in how much they succeed in building alliances with their clients (Dinger et al., 2008; Nissen-Lie et al., 2010). Thus, identifying therapist characteristics and behaviors that contribute to better alliances can be an important step towards a better understanding of between-therapist differences in treatment effectiveness. In the current paper, we aim to investigate the contribution of therapists’ observed alliance building behaviors, personality, and years of clinical experience to the alliance in home-based family treatment. Alliances in Family Treatment In conjoint family treatment, building alliances is complex for several reasons. First, the therapist simultaneously develops multiple alliances with different family members, who often have different or even conflicting needs and expectations of the treatment and the therapist. Second, family members observe and influence each other in their alliances with the therapist. Consequently, knowing they are observed by their partner, father, mother or children, familymembersmight feel unsafe and reluctant to be open and collaborative with the therapist (Friedlander et al., 2006a). A final complexity in building alliances in family treatment is that treatment outcome is not only affected by family members’ individual bond and collaboration with the therapist, but also by the extent to which family members form an alliance with each other, also referred to as the within- system alliance (Pinsof, & Catherall, 1986), or shared sense of purpose within the family (Escudero et al., 2008; Friedlander et al., 2006; Isserlin, & Couturier, 2012).