Marianne Welmers

Chapter 3 84 The fact that our findings on the therapists’ personality and alliance building behaviors in predicting mid-treatment alliance were significant even after controlling for early treatment alliance reports underlines the robustness of our findings. It indicates that regardless of fluctuations in alliance from early to mid-treatment, alliances are still relatively stronger when therapists are more agreeable, open and emotionally stable, and when they emotionally connect with family members and actively engage them in the treatment process. We also controlled for early treatment alliance building behaviors, but found no longitudinal contribution of therapist behaviors during early treatment to mid-treatment alliance reports of therapists and familymembers. This indicates that what therapists do during a specific session to strengthen the alliance only impacts therapists’ and family members’ evaluation of the alliance shortly after this session. Although not a specific focus of our study, it was interesting to find that therapists mainly invested in individual alliances with family members, but scarcely in systemic aspects of the alliance ( safety and shared sense of purpose ). This finding is in line with indications of Friedlander et al. (2019) that even highly experienced family therapists tend to focus mainly on individual alliances with family members, overlooking the importance of systemic aspects of the alliance, such as in-session safety and a shared purpose among family members. Although in our study more safety-promoting behaviors of the therapist were associated with less favorable therapist-reports of the alliance, several studies on alliance in family therapy indicate that family members’ in-session experience of safety (Friedlander et al., 2008b; Sotero et al., 2018) aswell the family’s sharedpurpose (Escudero et al., 2008; Friedlander et al., 2008b; Sotero et al., 2018) promote positive treatment outcomes of systemic family treatment. Recent meta-analytic findings show that these systemic aspects of the alliance seem to be even more vital for positive treatment outcomes than family members’ individual alliances with the therapist (Friedlander et al., 2018). These combined study findings emphasize the need for a systemic focus on the alliance in training and supervision of family therapists. This study has some limitations. First, because the subscale scores as originally developed for the SOFTA resulted in little variance and insufficient interrater reliability, we instead used behavioral frequencies for each SOFTA alliance domain, with moderate interrater reliability. This means we only investigated the quantitative contribution of positive alliance building behaviors, whereas negative behaviors as well as clinical importance and context of certain therapist behaviors can also impact the alliance (e.g. Ackerman & Hilsenroth, 2001; Boardman et al., 2006; Friedlander et al., 2006a; Muñiz de la Peña et al., 2012).