Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

Abstract

This study aimed to compare therapists' observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists' contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients' engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists' alliance-building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.

Family Therapy with Involuntary Clients. The Therapeutic Alliance as a Major Key to Therapy Success

“…Surprisingly, therapists' contributions for the safety dimension are almost non-existent in both groups although slightly higher in the voluntary group. This result shows that the management of conflict and intrafamilial hostility seems to be one of the areas that therapists probably find harder Sotero, Cunha, et al, 2017), which is particularly relevant both from a clinical point of view and as regards the therapists' learning and training (Sotero, Cunha, et al, 2017). In sum, and recognizing that on the first therapy session the alliances with the involuntary families are weaker, this study shows that therapists seem skilled enough to recognize the alliance problems and focus on creating strong therapeutic alliances by establishing differentiated behaviour patterns in response.…”

“…The alliance, in terms of the family as a whole, has been alternately conceptualized as allegiance (Symonds & Horvath, 2004), within-family alliance (Pinsof, 1994), and shared sense of purpose (Friedlander et al, 2006), referring not only to the willingness to collaborate in the therapy but also to the emotional bond between the family members (Friedlander, Escudero, Heatherington, & Diamond, 2011). Keeping this in mind we developed a set of studies that allowed us to define some specific profiles of the problem, as well as note some implications for therapy (Sotero, Cunha, Silva, Escudero, & Relvas, 2017;Sotero, Major, Escudero, & Relvas, 2016;Sotero, Moura-Ramos, Escudero, & Relvas, 2017).…”

“…Based on the results of the comparison between involuntary groups and voluntary groups, it can be stated that, particularly in the first session, therapists try to build and reinforce the therapeutic alliances, especially with involuntary families. To do so, they foment the engagement and the family unit, as well as the shared goals related to the therapy, through more numerous contributions in these dimensions (Sotero, Cunha, et al, 2017). It therefore seems that the therapists recognize the greatest difficulty areas of the therapeutic alliance with these kind of clients and realize the need to give them an intense and direct response (Sotero, Cunha, et al, 2017).…”

“…To do so, they foment the engagement and the family unit, as well as the shared goals related to the therapy, through more numerous contributions in these dimensions (Sotero, Cunha, et al, 2017). It therefore seems that the therapists recognize the greatest difficulty areas of the therapeutic alliance with these kind of clients and realize the need to give them an intense and direct response (Sotero, Cunha, et al, 2017). After engagement, the emotional connection dimension was found to have more contributions from therapists in both groups, both on the first and fourth sessions.…”

“…After engagement, the emotional connection dimension was found to have more contributions from therapists in both groups, both on the first and fourth sessions. The therapists participating in this study gave preference to strategies that promoted the therapeutic alliance by endorsing the engagement (explaining how therapy works, encouraging the definition of goals, asking what they want to discuss during the session) and establishing a good emotional connection with the clients (expressing trust in the clients' skills, using sense of humour, using self-disclosure) (Sotero, Cunha, et al, 2017). It can be said that the therapists choose contributions that increase the active participation of clients in the therapy and that leads to a positive affective and emotional connection with them.…”