Family therapy for maltreated youth: Can a strengthening therapeutic alliance empower change?

We tested the process of change in Alliance Empowerment Family Therapy (AEFT; Escudero, 2013), a systemic, team-based approach for treating child welfare involved families. Since building and balancing strong personal and within-family therapeutic alliances are crucial for motivating and sustaining change in these multistressed, overburdened families, we assessed alliance perceptions over time in relation to two indices of therapy outcome, youth functioning, and family-specific goal attainment. Specifically, we administered the self-report version of the System for Observing Family Therapy Alliances (Friedlander et al., 2006) following Sessions 3, 6, and 9 to 156 Spanish families seen by 20 therapists in six agencies whose mission is to serve child welfare referred maltreated youth. Results showed that AEFT delivered in M = 11.04 sessions (SD = 3.29) was effective in attaining family-specific goals and improving child functioning, d = 1.16, as rated by the therapist team in coordination with the referring caseworker. A unique aspect of the study was the modeling, at each time point, of the shared therapeutic system alliance, a latent variable consisting of the therapist's rating of the alliance as well as the alliance ratings of the youth and primary caregiver. As we hypothesized, shared alliance perceptions strengthened with time and positively predicted posttreatment outcomes. Moreover, a comparison of linear growth models with and without the therapist's perspective showed that inclusion of the therapist ratings in the shared alliance variables improved the predictability of child and family outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mapping the progress of the process: Codevelopment of the therapeutic alliance with maltreated adolescents.

We used a longitudinal actor-partner interdependence model to examine the codeveloping alliance in alliance empowerment therapy (AET; Escudero, 2013), a manualized team-based approach developed in Spain specifically for child welfare-involved youth. In this first evaluation of AET, we sampled 102 adolescents, 83% of whom had been removed from their homes due to abuse or neglect, and 40% of whom were in crisis at the time of referral. Before each session, clients rated their improvement-so-far; after each session, both clients and therapists completed a brief alliance measure, an adaptation of the System for Observing Family Therapy Alliances (SOFTA-s; Friedlander et al., 2006) for individual therapy. In terms of outcome, clients' improvement ratings were significantly associated with posttreatment changes in overall functioning and personal goal attainment. With respect to the change process, growth was observed in both clients' and therapists' ratings of the alliance over 12 sessions, and an increased similarity in alliance ratings was due to more rapid growth in the therapists' ratings than the clients' ratings. Dynamic structural equation modeling indicated that at higher levels of adolescent goal attainment, a stronger association was observed between increased therapist-rated alliance and goal attainment. In other words, in the most effective cases, therapists were more responsive to how the adolescents seemed to have experienced the alliance in the previous session. The cocreated alliance perceptions were due to therapist (rather than client) responsiveness, as well as to unspecified aspects of sharing a therapy environment over time, such as familiarity with the process, regular meetings, and so on. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Toward a broader understanding of split alliances in family therapy: Adding the therapist to the mix.

To broaden our understanding of a split alliance in family therapy, we investigated the frequencies and correlates of sessions in which therapists, youth, and caregivers reported markedly different perceptions of the alliance. The sample consisted of 156 Spanish families who received Alliance Empowerment Family Therapy (Escudero, Adolescentes y familias en conflicto, 2013) for child maltreatment. Family members and therapists rated the alliance on the SOFTA-s (Friedlander et al., Journal of Counseling Psychology, 2006, 53, 214) after sessions 3, 6, and 9; family members rated their perceptions of treatment progress before sessions 4, 7, and 10. A cluster analysis differentiated sessions with a split adult-youth alliance (27.7%) from a split family-therapist alliance (44.1%), and a balanced alliance (similar ratings across the three perspectives; 28.2%). Client-rated treatment progress was differentially associated with the type of alliance split and the average alliance rating, whereas better posttreatment outcomes (child functioning and family goal attainment) were associated with fewer sessions having either type of split alliance.

Con el fin de ampliar nuestros conocimientos de una alianza dividida en la terapia familiar, investigamos las frecuencias y las correlaciones de las sesiones en las cuales los terapeutas, los jóvenes y los cuidadores informaron percepciones marcadamente diferentes de la alianza. La muestra estuvo formada por 156 familias españolas que recibieron terapia familiar de empoderamiento y alianza (Escudero, 2013) para el maltrato infantil. Los miembros de la familia y los terapeutas calificaron la alianza en el SOATIF-s (Friedlander et al., 2006) después de las sesiones 3, 6 y 9; los familiares calificaron sus percepciones del avance del tratamiento antes de las sesiones 4, 7 y 10. Un análisis de agrupamiento diferenció las sesiones con una alianza dividida entre los adultos y los jóvenes (27.7 %) de una alianza dividida entre la familia y el terapeuta (44.1 %) y una alianza equilibrada (calificaciones similares entre las tres perspectivas; 28.2 %). El avance del tratamiento calificado por el paciente estuvo asociado diferencialmente con el tipo de alianza dividida y la calificación promedio de la alianza, mientras que los mejores resultados posteriores al tratamiento (el funcionamiento del niño y el logro de objetivos familiares) estuvieron asociados con menos sesiones que tenían cualquiera de los tipos de alianza dividida.

Building an Expanded Therapeutic Alliance: A Task Analysis with Families Trapped in Parental-Adolescent Conflict.

Parental-adolescent conflict is part of the normal developmental cycle of families, but when it occurs in a dysfunctional way, it is associated with the appearance of various harmful conditions for the family system and for the adolescent in particular. Family therapy is one of the main options for psychotherapeutic intervention in these cases and has ample evidence of its effectiveness. The success of this intervention is conditioned to the construction of an adequate therapeutic alliance with the family, but the process of this task has not been clarified yet. The present study is a task analysis, the purpose of which was to create a heuristic model of how an expanded alliance may be built in these kinds of cases. The model was revised and improved from the intensive analysis of six cases. The resulting model can be a useful guide for family therapists in that it describes the specific client and therapist behaviors involved in balancing the alliance, as well as the potential obstacles and suggested ways to resolve them.