Marianne Welmers

Alliance Discrepancies 91 CHAPTER 4 Introduction The therapeutic or working alliance has been long studied, and both clinicians and scholars assume that building strong alliances with clients is a significant contributor to positive outcomes of psychotherapy. Generally, alliance is defined as a professional relationship between a therapist and his or her patient, consisting of an emotional bond and agreement on what goals and tasks should be central in therapy (Bordin, 1979; Elvins & Green, 2008). Indeed, the alliance has proven to be a significant common factor in determining effectiveness of psychosocial treatment of adults (Flückiger et al., 2018), youths (Karver et al., 2018; Murphy & Hutton, 2018), and families (Friedlander et al., 2018; Welmers-van de Poll et al., 2018). In conjoint family treatment, building alliances is complex, because the therapist simultaneously develops alliances with different familymembers (Friedlander et al., 2006). Given the differences between familymembers in their expectations of the treatment and the therapist, the strength of these alliancesmight differ and thus, discrepancies between alliances of different family members with the therapist might occur. Previous studies indicate that alliance discrepancies within the family contribute to treatment dropout (Muñiz de la Peña et al., 2009; Robbins et al., 2008; Robbins et al., 2003). Moreover, in a meta-analytic study on alliance in couple and family therapy, such alliance discrepancies have been found to be an even stronger predictor of unfavorable treatment outcome as compared to problematic individual alliances with the therapist (Friedlander et al., 2018). Although research on alliance in family treatment has burgeoned during the last two decades (for a meta-analysis, see Welmers-van de Poll et al., 2018), there is only scarce research that captures aspects of the alliance typical of family treatment, such as alliance discrepancies. Important questions on how alliance processes in a systemic context evolve, interact, and can most favorably be assessed during treatment yet remain unanswered. First, the development of discrepancies in alliance between familymembers over the course of treatment is still underresearched. Second, despite the notion that the therapist is likely to play a key role in the alliance–outcome association (Baldwin, Wampold, & Imel, 2007), and should detect and repair problematic alliance discrepancies, it is yet unclear if and how the therapist takes account of multiple alliances and their discrepancies in family treatment. To solve these issues, in this study we aimed to examine the occurrence and development of alliance discrepancies in a Dutch home-based family treatment for youth problems, paying particular attention to the therapist’s evaluation of multiple alliances and their discrepancies.