When the family is opposed to coming to therapy: A study on outcomes and therapeutic alliance with involuntary and voluntary clients.

Abstract

The purpose of this study was to explore the effects of alliance dimensions and involuntary versus voluntary referral status on the therapy outcomes in family therapy. The first and fourth sessions of 29 therapeutic processes with involuntary and voluntary families seen in family brief therapy were rated with the System for Observing Family Therapy Alliances . This instrument evaluates four dimensions of the therapeutic alliance (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family). The outcomes were measured with the Goal Attainment Scaling (Kiresuk, Smith, & Cardillo, 1994). The obtained results highlight two main conclusions: (a) There were no differences in the outcomes between involuntary and voluntary families and (b) in the fourth session only, there was a significant effect of "Safety within the therapeutic system" and "Shared purpose within the family" on the outcomes, namely, those alliance dimensions that are unique for conjoint therapy. Important clinical implications are discussed concerning the therapeutic work with involuntary families.

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

“…However, as was true in individual treatment, by the fourth session, most of the between groups differences disappeared. In a recent study, Sotero, Moura‐Ramos, Escudero, and Revlas () found no differences in outcomes between treatment with voluntary and involuntary families and found that the family's within‐system alliance was central in successful outcomes with both types of clients. It is unclear whether these conclusions can be applied to couple therapy and to those who do not experience legal coercion to attend treatment.…”

Long-term mental health services use in children referred to a clinical intervention

“…While the small sample size precludes drawing definitive conclusions, this outcome reflects concerns that the lack of initiative in mandated participation acts as a barrier to treatment progress (Mirick, 2018). At the same time, the possibility that mandated families become engaged during treatment, achieving results similar to voluntary attendees, cannot be ruled out (Sotero et al, 2018). In support of this view, one preliminary examination found no differences in PCIT-taught parenting skills and self-reported treatment acceptability by type of referral (Timmer, Urquiza, Boys, & Forte, 2014).…”

“…Despite the wide use of this practice, there is no consensus on the effectiveness of court-mandated attendance with CSW-involved families. Reports range from success attributed to consistent attendance (Geller & Srikameswaran, 2006;Snyder & Anderson, 2009) to null effects (Sotero, Moura-Ramos, Escudero, & Relvas, 2018), to ethical concerns regarding the dampening effect of mandated attendance on families' agency, motivation, and readiness for change (Mirick, 2018).…”