Working (on) alliances A systemic perspective on alliances and their relation to outcome in home-based family treatment for youth problems

Home-based family treatment (HBFT) is the most provided service in youth care, serving families with complex child and parenting problems. Empirical evidence indicates varying outcomes of HBFT, and thus it is important to examine factors that may contribute to desirable outcomes. The current dissertation aimed at investigating such an important factor: the working alliance. The central aim was to investigate alliance processes in (home-based) family treatment in relation to outcome, paying particular attention to the therapists’ role and to the systemic complexity of building multiple interacting alliances with and within the family. The dissertation opens with a meta-analytic review of previous studies on the alliance-outcome association in family-involved treatment for youth problems. In the remaining chapters the working alliance is investigated from multiple perspectives, based on multi-informant questionnaire and observational data on alliances and treatment outcome in a Dutch HBFT for youth problems.
Findings underline the importance and complexity of building strong working alliances with families receiving (home-based) treatment. It indicates that clinical practice as well as education and training of providers of (home-based) family treatment may benefit from a focus on actively engaging family members in the treatment process and investing in strong emotional bonds. The findings also underscore the importance of a more systemic perspective on the working alliance both in research and practice. This includes addressing the process of building multiple interacting alliances with different family members, engaging children and adolescents in a conjoint treatment process with parents, and promoting the family’s collaboration on shared goals.