The therapeutic alliance with involuntary clients: how does it work?

Abstract

This study aimed to compare involuntary and voluntary clients in the establishment of the therapeutic alliance in the context of family therapy. The system for observing family therapy alliances was used to rate the alliance in sessions 1 and 4 from videotapes of 40 families seen in brief family therapy. This instrument has four alliance dimensions. In the first session, results showed that the clients who sought therapy voluntarily demonstrated more alliance-related behaviour than did involuntary clients in all alliance dimensions. In the fourth session, however, only the Engagement dimension showed group differences. Notably, there also were group differences in the evolution of the alliance from the first to the fourth session in the Safety dimension, with the voluntary clients developing this dimension more negatively. The results are discussed in terms of the specific characteristics of involuntary clients, as well as the implications for practice. Practitioner points• Be aware of differing motives, motivations, and degrees of readiness for therapy within the family • Inquire about the amount of pressure experienced by clients, and the source of that pressure, early in the family therapy • Promote and monitor the therapeutic alliance with involuntary clients • Promote a safe context, providing structure and guidelines for safety and confidentiality and helping clients to talk truthfully

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

“…This study's sample of therapists included participants in a larger research project about involuntary clients in the context of brief family therapy (see Sotero et al., , for details). The clinical cases that met the selection criteria (involuntary and voluntary, as explained below) came from an archival dataset of a Portuguese university center for family therapy.…”

“…Considering the initial difficulties of establishing a therapeutic alliance with involuntary clients (Honea‐Boles & Griffin, ; Snyder & Anderson, ; Sotero et al, ), we hypothesize that therapists tend to contribute more to alliances with involuntary clients than to alliances with voluntary clients, at least at the beginning of therapy (first session). If this hypothesis is correct, the results can corroborate the idea that to some extent, therapists are able to change their behaviors to improve poor alliances.…”

“…These clients are often willing to engage with the therapist and form an alliance, and they are motivated to collaborate to make changes through therapy (O'Hare, 1996;Prochaska, Johnson, & Lee, 2008). Therefore, the notion of an "involuntary client" refers to both the institutional referral and the clients' unwillingness to be in therapy (Sotero, Major, Escudero, & Relvas, 2016). A subset of involuntary clients comprises those who are legally referred to therapy (by the court or state agencies) and who face legal consequences if they leave therapy-mandated clients (Rooney, 2009).…”

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

“…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).…”

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

“…Other evidence supports the idea that the active stage of therapeutic change is not necessarily a smooth one, and that various components of family alliance evolve differently for different clients, and that timing of alliance assessments is important. Sotero, Major, Escudero, and Relvas's (2016) recent study of the observed family alliance at sessions 1 and 4 in brief systemic therapy showed that voluntary and involuntary clients differed on all alliance dimensions in the beginning of therapy; however, by the fourth session the differences disappeared for all components except engagement. Clients also reported an unexpected decrease in the safety and shared purpose components of family alliance over time.…”