Marianne Welmers

Therapists’ Contributions to the Alliance 83 CHAPTER 3 engagement behaviors (Welmers – van de Poll & Stams, 2019). There was no effect of clinical experience on any observed mid-treatment behaviors or for early treatment emotional connection and safety behaviors. Note that in thepresent studyweonlyexamined therapists’ and family members’ ratings of their individual alliances, since there were no therapist- or self-reports on safety or shared sense of purpose . Future research could investigate whether perhaps the more complex aspects of alliance in conjoint treatment, such as creating a safe therapeutic environment for each family member or enhancing the within-family alliance, are more affected by the therapists’ clinical experience. Regarding therapists’ observed in-session alliance building behaviors in the present study, we found that observed engagement and emotional connection behaviors predicted both their own and family members’ reports of the alliance, which was in line with our hypotheses. In a previous study investigating observations of client behaviors in relation to self- and therapist-reports of alliance, engagement and emotional connection behaviors of family members were also positively associated with their self-reports, but not with therapist-reports (Friedlander et al., 2006b). Our finding indicates that when the therapist actively engages family members in the treatment process and connects with them at an emotional level, both the therapist and the family evaluate the alliance as more positive. In contrast to our expectations, therapists’ and family members’ reports of the alliance were negatively associatedwith therapists’ in-session safety behaviors, such as providing structure and guidelines for safety and confidentiality or actively protecting one family member from another. This is remarkable given the low occurrence of these behaviors in the included observed sessions. The negative direction of the association was replicated in predicting family members’ reports of the alliance, although this association just failed to reach significance. Our finding could indicate that therapists’ safety interventions have a negative effect on the alliance, even when applied scarcely. However, two previous studies including observations of family members’ in-session safety behaviors indicate that a sense of safety in the therapeutic context does promote positive outcome of systemic family treatment (Friedlander et al., 2008b; Sotero et al., 2018). An alternative explanation for our finding may be that therapists increase their investment in safety when they perceive their alliance with family members as less favorable. This presumed mechanism is in line with Escudero and Friedlander’s (2017) proposed strategy for navigating alliances in challenging contexts of family treatment. They argue that a sense of safety among family members who are in treatment together is an essential precondition for facilitating strong bonds between the therapist and each familymember, as well as for facilitating family members’ engagement in the treatment process and their shared sense of purpose.