Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Abstract

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents' and youths' perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.

Client engagement in psychotherapeutic treatment and associations with client characteristics, therapist characteristics, and treatment factors

“…Qualitative methods (interviews, focus groups, observations -see Table 1, appendix A) were employed in only four of the engagement-defined studies James, Cushway, & Fadden, 2006;Thompson et al, 2007;Wagner et al, 2003). In all but the study by Wagner et al (2003), engagement was interpreted as representing clients' perceptions of the therapist or the therapists' perceptions of the development of the therapeutic relationship.…”

“…Family intervention therapists in the study by James et al (2006) referred to engagement as "the careful establishment of a trusting relationship involving a commitment to an agreed piece of work" (James et al, 2006, p.363). Families (Thompson et al, 2007) and female clients in substance abuse treatment ) referred to non-judgemental counselling staff that treated them with respect, listened to them and understood their experiences. These interpersonal skills described in the qualitative literature are consistent with conceptualizations of the therapeutic alliance (Horvath et al, 2011) and in keeping with a solution-focused approach (Berg & De Jong, 1996) and the global characteristics assessed by the motivational interviewing skills code (MISC : Miller, Moyers, Ernst, & Amrhein, 2003) of empathy, acceptance, egalitarianism, warmth and genuineness.…”

“…Grounded theory Defined by therapists as 'The careful establishment of a trusting relationship involving a commitment to an agreed piece of work' Thompson et al (2007) 19 families in a family therapy intervention Content analysis Defined by clients as being listened to, understood, and accepted by, calm, nonjudgemental, friendly, genuine therapists Wagner et al (2003) 24 home visitors and 667 families from PAT kkkk sites Exploratory study resulting from a randomized experimental study…”

Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists

“…[27][28][29][30][31][32][33] Using non-stigmatising language, facilitating the teenager's sense of being accepted and validated, and the therapist conveying respect were consistent themes that emerged in this literature.…”

Therapy talk and talk about therapy : Client-identified important events in psychotherapy

“…Thompson, Bender, Lantry, and Flynn (2007) interviewed 19 families with adolescents who were all in home-based treatment and found that participants preferred a collaborative therapy relationship with a calm, casual, authentic, caring and impartial therapist. Other helpful aspects that the participants expressed were gaining insights and developing new skills related to communication and family relationships.…”