Contemporary Family Therapy

, Volume 29, Issue 1–2, pp 39–55 | Cite as

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

  • Sanna J. Thompson
  • Kimberly Bender
  • Janet Lantry
  • Patrick M. Flynn
Original Paper


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.


High-risk youth Family based treatment Therapeutic alliance Treatment engagement 



This manuscript was supported in part by a Career Development Award (K01-DA015671) from the National Institute of Drug Abuse to Dr. Thompson.


  1. Azrin, N. H., Donohue, B., Besalel, V. A., Kogan, E. S., & Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child and Adolescent Substance Abuse, 3(3), 3–15CrossRefGoogle Scholar
  2. Bachelor, A. (1995). Clients’ perceptions of the therapeutic alliance: A qualitative analysis. Journal of Counseling Psychology, 42(3), 323CrossRefGoogle Scholar
  3. Beck, M., Friedlander, M. L., & Escudero, V. (2006). Three perspectives on clients’ experiences of the therapeutic alliance: A discovery-oriented investigation. Journal of Marital and Family Therapy, 32(3), 355–368PubMedCrossRefGoogle Scholar
  4. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, Ttheory, Research and Practice, 16(3), 252–260Google Scholar
  5. Broome, K. M., Joe, G. W., & Simpson, D. D. (2001). Engagement models for adolescents in DATOS-A. Journal of Adolescent Research, 16(6), 608–610CrossRefGoogle Scholar
  6. Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313–327PubMedCrossRefGoogle Scholar
  7. Cunningham, P. B., & Henneggler, S. W. (1999). Engaging multiproblem families in treatment: Lessons learned throughout the development of multisystemic therapy. Family Process, 38(3), 265–281PubMedCrossRefGoogle Scholar
  8. Dearing, R. L., Barrick, C., Dermen, K. H., & Walitzer, K. S. (2005). Indicators of client engagement: Influences on alcohol treatment satisfaction and outcomes. Psychology of Addictive Behaviors, 19(1), 71–78PubMedCrossRefGoogle Scholar
  9. Diamond, G. S., & Liddle, H. A. (1999). Transforming negative parent-adolescent interactions: From impasse to dialogue. Family Process, 38(1), 5–26PubMedCrossRefGoogle Scholar
  10. Diamond, G. M., Liddle, H. A., Hogue, A., & Dakof, G. A. (1999). Alliance-building interventions with adolescents in family therapy: A process study. Psychotherapy, 36(4), 355–368Google Scholar
  11. Digiuseppe, R., Linscott, J., & Jilton, R. (1996). Developing the therapeutic alliance in child-adolescent psychotherapy. Applied and Preventive Psychology, 5(2), 85–100CrossRefGoogle Scholar
  12. Eltz, M. J., Shirk, S. R., & Sarlin, N. (1995). Alliance formation and treatment outcome among maltreated adolescents. Child Abuse and Neglect, 19(4 (Print)), 419–431PubMedCrossRefGoogle Scholar
  13. Friedlander, M. L., Horvath, A. O., Cabero, A. S., Escudero, V., Heatherington, L., & Martens, M. P. (2006). System for observing family therapy alliances: A tool for research and practice. Journal of Counseling Psychology, 53(2), 214–225CrossRefGoogle Scholar
  14. Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139CrossRefGoogle Scholar
  15. Hougaard, E. (1994). The therapeutic alliance—a conceptual analysis. Scandinavian Journal of Psychology, 35, 67–85PubMedGoogle Scholar
  16. Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26(1), 50–65PubMedCrossRefGoogle Scholar
  17. Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65(3), 453–463PubMedCrossRefGoogle Scholar
  18. Kazdin, A. E., Marciano, P. L., & Whitley, M. K. (2005). The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior. Journal of Consulting and Clinical Psychology, 73(4), 726–730PubMedCrossRefGoogle Scholar
  19. Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: Methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44(8), 1116–1129PubMedCrossRefGoogle Scholar
  20. Kazdin, A. E., Siegel, T. C., & Bass, D. (1990). Drawing on clinical practice to inform research on child and adolescent psychotherapy: Survey of practitioners. Professional Psychology: Research and Practice, 21(3), 189–198CrossRefGoogle Scholar
  21. Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S. M., Hoven, W. E., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 889–897PubMedCrossRefGoogle Scholar
  22. Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejeda, M. (2001). Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse, 27(4), 651–688PubMedCrossRefGoogle Scholar
  23. Martin, J., Romas, M., Medford, M., Leffert, N., & Hatcher, S. L. (2006). Adult helping qualities preferred by adolescents. Adolescence, 41(161), 127–140PubMedGoogle Scholar
  24. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage, PublicationsGoogle Scholar
  25. Patton, M. Q. (2001). Qualitative evaluation and research methods (3rd ed.). Newbury Park: Sage PublicationsGoogle Scholar
  26. Pinsof, W. M., Horvath, A. O., & Greenberg, L. S. (1994). An integrative systems perspective on the therapeutic alliance: Theoretical, clinical, and research implications. In A. O. Horvath, & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice. (pp. 173–195). New York: WileyGoogle Scholar
  27. Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2005). Adolescent and parent alliance and treatment outcome in multidimensional family therapy. Journal of Consulting and Clinical Psychology, 73(4), 689–698PubMedCrossRefGoogle Scholar
  28. Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71(3), 452PubMedCrossRefGoogle Scholar
  29. Spoth, R., Redmond, C., Hockaday, C., & Shin, C. Y. (1996). Barriers to participation in family skills preventive interventions and their evaluations. Family Relations, 45(3), 247–255CrossRefGoogle Scholar
  30. Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin, 122(2), 170–191PubMedCrossRefGoogle Scholar
  31. Thomas, M. L. (2006). The contributing factors in a therapeutic process. Contemporary Family Therapy, 28, 201–210CrossRefGoogle Scholar
  32. Thompson, S. J., Pollio, D., Eyrich, K., Bradbury, E., & North, C. S. (2004). Successfully exiting homelessness: Experiences of formerly homeless mentally ill individuals. Evaluation and Program Planning, 27(4), 423–431CrossRefGoogle Scholar
  33. Waldron, H. B. (1997). Adolescent substance abuse and family therapy outcome: A review of randomized trials. Advances in Clinical Child Psychology, 19, 199–234Google Scholar
  34. Waldron, H. B., Slesnick, N., Brody, J. L., Turner, C. W., & Peterson, T. R. (2001). Treatment outcomes for adolescent substance abuse at 4 and 7 month assessment. Journal of Consulting and Clinical Psychology, 69(5), 802–813PubMedCrossRefGoogle Scholar
  35. Wang, M-N, Sandberg, J., Zavada, A., Mittal, M., Gosling, A., Rosenberg, T., et al. (2006). “Almost there”...Why clients fail to engage in family therapy: An exploratory study. Contemporary Family Therapy, 28(2), 211–224CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Sanna J. Thompson
    • 1
  • Kimberly Bender
    • 1
  • Janet Lantry
    • 1
  • Patrick M. Flynn
    • 2
  1. 1.School of Social WorkUniversity of Texas at AustinAustinUSA
  2. 2.Institute of Behavioral ResearchTexas Christian UniversityFort WorthUSA

Personalised recommendations