Alliance in couple and family therapy.

Abstract

Couple and family therapy (CFT) is challenging because multiple interacting working alliances develop simultaneously and are heavily influenced by preexisting family dynamics. An original meta-analysis of 24 published CFT alliance-retention/outcome studies (k = 17 family and 7 couple studies; N = 1,416 clients) showed a weighted aggregate r = .26, z = 8.13 (p < .005); 95% CI = .33, .20. This small-to-medium effect size is almost identical to that reported for individual adult psychotherapy (Horvath, Del Re, Flückiger, & Symonds, this issue, pp. 9-16). Analysis of the 17 family studies (n = 1,081 clients) showed a similar average weighted effect size (r = .24; z = 6.55, p < .005; 95% CI = .30, .16), whereas the analysis of the 7 couple therapy studies (n = 335 clients) indicated r = .37; z = 6.16, p < .005; 95% CI = .48, .25. Tests of the null hypothesis of homogeneity suggested unexplained variability in the alliance-outcome association in both treatment formats. In this article we also summarize the most widely used alliance measures used in CFT research, provide an extended clinical example, and describe patient contributions to the developing alliance. Although few moderator or mediator studies have been conducted, the literature points to three important alliance-related phenomena in CFT: the frequency of "split" or "unbalanced" alliances, the importance of ensuring safety, and the need to foster a strong within-family sense of purpose about the purpose, goals, and value of conjoint treatment. We conclude with a series of therapeutic practices predicated on the research evidence.

Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study

“…Friedlander et al (2011) showed similar results for family-therapy ( d = 0.49; r = 0.24). The present study emphasizes the impact of the collaboration and shows its importance in therapeutic work with MPF, especially in relation to treatment outcome expectancy and adversities within a family .…”

Alliance and Group Cohesion in Relationship Education

“…The lack of association between participant-leader alliance and outcome is surprising given the notable literature supporting this association in the psychotherapy literature (e.g., Friedlander et al, 2011;Horvath et al, 2011), as well as the initial findings in the REP literature (Bourgeois et al, 1990;Owen et al, 2011). In contrast to past REP alliance research, this study examined relationship outcomes for individuals who were in a relationship and yet were attending the REP without their partner.…”

Addressing the Person of the Therapist in Supervision: The Therapist's Inner Conversation Method

“…Although the therapeutic alliance is a common factor in psychotherapy in general, forming an expanded alliance in family therapy is a common factor specific to marital and family therapy (Sprenkle et al, 2009). Alliance formation in marital and family therapy is particularly complex (Friedlander et al, 2011;Sexton & Datachi, 2014) and can be viewed as a dance in which everyone participates (Sprenkle et al, 2009). To form and maintain such a complex alliance attention to the therapist's experiencing can be of great value.…”