Alliance and termination status in couple therapy: A comparison of methods for assessing discrepancies

Abstract

Much of the empirical data available about therapeutic alliance and its relationship to termination status come from individual psychotherapies. We know less about therapeutic alliance in couple therapy. A unique characteristic of alliance in couple or family therapy is the possibility of discrepancies in alliance between system members. In this study we sought to demonstrate three statistical techniques: standard deviations, the intraclass correlation to assess discrepancies in alliance over time during the initial stage of couple therapy, and the use of these various measures to predict termination status using a sample of 72 couples from a university-based training clinic. Differences in partners' alliances operationalized either as categorical or continuous variables but when analyzed separately at each time point were not predictive of termination status. When multilevel modeling was used, a difference in the way the discrepancies changed over a period of time was related to termination status.

Caregiver–Adolescent Dyadic Disagreement and Problem Behaviors of Adolescents in the Child Welfare System

“…Finally, in Pair #4, caregiver and adolescent scores exhibited dissimilar shape, elevation, and scatter. Negative values resulted ( r = −.72; ICC = −.52), which can be interpreted as reflecting dyad scores that are less similar than a randomly matched pair (Bartle‐Haring , Glebova, Gangamma, Grafsky, & Delany, ). However, Furr () argued it is unlikely that ICC “captures all three in a way that is clear and conceptually coherent…given the conceptual independence of these elements” (p. 12).…”

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis

“…Often, raw difference scores are used to investigate the role of split alliances in treatment outcome. Previous research, however, has shown that these difference scores cannot provide valid and reliable tests of informant discrepancy as a predictor (Bartle-Haring et al 2012 ; Laird and De Los Reyes 2013 ).…”

“…As pointed out before, the scarce research on split alliances that is available often lacks a clear definition of the concept, and applied methodology in most of these studies might not be appropriate for investigating the role of split alliances in treatment effectiveness. For research on split alliances, applying methods other than using discrepancy scores is recommended, such as multilevel modeling (Bartle-Haring et al 2012 ) or polynomial regression (Laird and De Los Reyes 2013 ).…”

Therapists’ and Clients’ Perceptions of Bonding as Predictors of Outcome in Multisystemic Therapy®

“…To measure balanced alliance, or “alliance similarity,” we calculated intraclass correlations (ICC) between (a) the caregiver's and therapist's reports on WAI items, and (b) the caregiver's and youth's reports on WAI items. Although a variety of approaches have been used to calculate differences in perceptions of alliance (see Bartle‐Haring et al., ), we followed Kenny, Kashy, and Cook's () recommendations for choosing an appropriate dyadic assessment of the correspondence between two sets of scores. The ICC reflects similarities in levels and profiles of measures (in our case, WAI items), regardless of absolute levels, and is normalized by the spread: 1.0 indicates exact similarity, −1.0 indicates maximal dissimilarity, and 0 indicates chance similarity (see Table for means and SD s).…”

“…Consideration of individual alliances can be especially important in modalities that include both individual and family sessions. An unbalanced alliance (also referred to as discrepant or split alliance; Bartle‐Haring, Glebova, Gangamma, Grafsky, & Ostrom Delaney, ; Friedlander et al., ; Muniz De La Pena, Friedlander, & Escudero, ; Robbins, Turner, Alexander, & Perez, ) occurs when family members differ in their strength of alliance with the therapist. Robbins and colleagues (Robbins et al., , , ) examined within‐family differences in alliance in the context of Brief Strategic Family Therapy (BSFT), Functional Family Therapy (FFT), and Multidimensional Family Therapy (MDFT) for adolescents with substance abuse or behavioral problems.…”