Advertisement

Using the Therapeutic Alliance to Empower Couples and Families

  • Valentín Escudero
  • Myrna L. Friedlander
Chapter
Part of the Focused Issues in Family Therapy book series (FIFT)

Abstract

In this introductory chapter we explain the perspective taken in this book, i.e., that regardless of their theoretical orientation, therapists need to purposefully balance their alliances with multiple family members in order to empower individuals, subsystems, and the couple or family unit for therapeutic gain. The more complex and resistant the family, the more essential and decisive it is to create strong alliances. As a theoretical framework we introduce our pan-theoretical, systemic perspective on alliances in couple and family therapy (CFT), the distinguishing feature of which is a primary concern with shifting the interpersonal dynamics that maintain psychosocial problems and family dysfunction. Next, we describe in a very practitioner-friendly language, our System for Observing Family Therapy Alliances (SOFTA; Friedlander, Escudero, & Heatherington, Therapeutic Alliances with Couples and Families: An Empirically-Informed Guide to Practice. Washington, DC: American Psychological Association, 2006), the four-dimension model (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety Within the Therapeutic System, and Shared Sense of Purpose Within the Family), its measures, supporting research, and use in practice, training, and clinical supervision. In doing so, we highlight aspects of the alliance unique to conjoint treatment—the need to ensure safety for family members who are in conflict with one another, who are at different developmental levels, and who may have differing motivations—all of which present specific challenges for effective conjoint CFT. Additionally, we discuss alliance rupture and repair processes, split or unbalanced alliances, individual differences in alliance formation and maintenance, and differences between alliances in challenging and not-so-challenging couple and family cases.

Keywords

Therapeutic alliance System for Observing Family Therapy Alliances SOFTA Challenging cases Alliance rupture Split alliances Safety Emotional connection Engagement in the therapy Within-family alliance 

References

  1. Anker, M. G., Owen, J., Duncan, B. L., & Sparks, J. A. (2010). The alliance in couple therapy: Partner influence, early change, and alliance patterns in a naturalistic sample. Journal of Consulting and Clinical Psychology, 78, 635–645.CrossRefPubMedGoogle Scholar
  2. Bartle-Haring, S., Glebova, T., Gangamma, R., Grafsky, E., & Delaney, R. O. (2012). Alliance and termination status in couple therapy: A comparison of methods for assessing discrepancies. Psychotherapy Research, 22, 502–514.CrossRefPubMedGoogle 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, 355–368.CrossRefPubMedGoogle Scholar
  4. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, 16, 252–260.CrossRefGoogle Scholar
  5. Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson.Google Scholar
  6. Brock, R. L., Kroska, E., & Lawrence, E. (2016). Current status of research on couples. In T. L. Sexton & J. Lebow (Eds.), Handbook of family therapy (4th ed., pp. 409–433). New York: Routledge.Google Scholar
  7. Cabero Alvarez, A. (2004). Patrones de interacción y relación terapéutica: Control de la relación y clima afectivo en la interacción terapeutapaciente [Patterns of interaction and the therapeutic relationship: Relationship control and affect climate in the therapist–patient interaction]. Unpublished doctoral dissertation, University of Salamanca, Spain.Google Scholar
  8. Carpenter, J., Escudero, V., & Rivett, M. (2008). Training family therapy students in conceptual and observational skills related to the therapeutic alliance: An evaluation. Journal of Family Therapy, 30, 409–422.CrossRefGoogle Scholar
  9. Chang, D. F., & Berk, A. (2009). Making cross-racial therapy work: A phenomenological study of clients’ experiences of cross-racial therapy. Journal of Counseling Psychology, 56, 521–536.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Christensen, A., & Heavey, C. L. (1990). Gender and social structure in the demand/withdraw pattern of marital conflict. Journal of Personality and Social Psychology, 59, 73–81.CrossRefPubMedGoogle Scholar
  11. Constantine, M. G. (2007). Racial microaggressions against African American clients in cross-racial counseling relationships. Journal of Counseling Psychology, 54, 1–16.CrossRefGoogle Scholar
  12. Coulehan, R., Friedlander, M. L., & Heatherington, L. (1998). Transforming narratives: A change event in constructivist family therapy. Family Process, 37, 17–33.CrossRefPubMedGoogle Scholar
  13. 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, 355–368.CrossRefGoogle Scholar
  14. Escudero, V., Boogmans, E., Loots, G., & Friedlander, M. L. (2012). Alliance rupture and repair in conjoint family therapy: An exploratory study. Psychotherapy, 49, 26–37.CrossRefPubMedGoogle Scholar
  15. Escudero, V., & Friedlander, M. L. (2003). El sistema de observación de la alianza terapeutica en intervención familiar (SOATIF): Desarrollo trans-cultural, fiabilidad, y aplicaciones del instrumento. Mosaico (Journal of the Spanish Federation of Family Therapy Associations), 25, 32–36. (Reprinted in Perspectivas Systemicas, Vol. 15, Issue 77, 2003).Google Scholar
  16. Escudero, V., & Friedlander, M. L. (2016). E-SOFTA: A video-based software for observing the working alliance in clinical training and supervision. In T. Rousmaniere & E. Renfro-Michel (Eds.), Using technology to enhance clinical supervision. (pp. 223–238). American Counseling Association: Alexandria, VA.Google Scholar
  17. Escudero, V., Friedlander, M. L., & Heatherington, L. (2011). Using the e-SOFTA for video training and research on alliance-related behavior. Psychotherapy , 48, 138–147.CrossRefPubMedGoogle Scholar
  18. Escudero, V., Friedlander, M. L., Varela, N., & Abascal, A. (2008). Observing the therapeutic alliance in family therapy: Associations with participants’ perceptions and therapeutic outcomes. Journal of Family Therapy, 30, 194–204.CrossRefGoogle Scholar
  19. Friedlander, M. L., Bernardi, S., & Lee, H. H. (2010). Better versus worse family therapy sessions as reflected in clients’ alliance-related behavior. Journal of Counseling Psychology, 57, 198–204.CrossRefPubMedGoogle Scholar
  20. Friedlander, M. L., & Diamond, G. M. (2011). Couple and family therapy. In E. Altmaier & J. Hansen (Eds.), Oxford handbook of counseling psychology (pp. 647–675). New York: Oxford University Press.Google Scholar
  21. Friedlander, M. L., Escudero, V., & Heatherington, L. (2006). Therapeutic alliances with couples and families: An empirically-informed guide to practice. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  22. Friedlander, M. L., Escudero, V., Heatherington, L., & Diamond, G. M. (2011). Alliance in couple and family therapy. Psychotherapy, 48, 25–33.CrossRefPubMedGoogle Scholar
  23. Friedlander, M. L., Escudero, V., Horvath, A. S., Heatherington, L., Cabero, A., & Martens, M. P. (2006). System for observing family therapy alliances: A tool for research and practice. Journal of Counseling Psychology, 53, 214–225.CrossRefGoogle Scholar
  24. Friedlander, M. L., Heatherington, L., & Escudero, V. (2016). Research on change mechanisms: Advances in process research. In T. Sexton & J. Lebow (Eds.), Handbook of family therapy (4th ed., pp. 454–467). New York: Routledge.Google Scholar
  25. Friedlander, M. L., Heatherington, L., Johnson, B., & Skowron, E. A. (1994). “Sustaining engagement”: A change event in family therapy. Journal of Counseling Psychology, 41, 438–448.CrossRefGoogle Scholar
  26. Friedlander, M. L., Kivlighan, D. M., & Shaffer, K. (2012). Exploring actor-partner interdependence in family therapy: Whose view (parent or adolescent) best predicts treatment progress? Journal of Counseling Psychology, 59, 168–175.CrossRefPubMedGoogle Scholar
  27. Friedlander, M. L., Lambert, J. E., Escudero, V., & Cragun, C. (2008). How do therapists enhance family alliances? Sequential analyses of therapist → client behavior in two contrasting cases. Psychotherapy: Theory, Research, Practice, Training, 45, 75–87.CrossRefGoogle Scholar
  28. Friedlander, M. L., Lambert, J. E., & Muñiz de la Peña, C. (2008). A step toward disentangling the alliance/improvement cycle in family therapy. Journal of Counseling Psychology, 55, 118–124.CrossRefGoogle Scholar
  29. Friedlander, M. L., Lee, H. H., Shaffer, K. S., & Cabrera, P. (2014). Negotiating therapeutic alliances with a family at impasse: An evidence-based case study. Psychotherapy, 51, 41–52.CrossRefPubMedGoogle Scholar
  30. Heatherington, L. (1987). Therapists’ personalities and their evaluations of three family therapy styles: An empirical investigation. Journal of Marital and Family Therapy, 13, 167–178.CrossRefGoogle Scholar
  31. Heatherington, L., Escudero, V., & Friedlander, M. L. (in press). Where systems theory and alliance meet: Relationship and technique in family therapy. In O. Tishby & H. Wiseman (Eds.), Developing the therapeutic relationship: Integrating case studies, research and practice. Washington, DC: American Psychological Association.Google Scholar
  32. Heatherington, L., & Friedlander, M. L. (1990). Couple and family psychotherapy alliance scales: Empirical considerations. Journal of Marital and Family Therapy, 16, 299–306.CrossRefGoogle Scholar
  33. Higham, J., Friedlander, M. L., Escudero, V., & Diamond, G. M. (2012). Engaging reluctant adolescents in family therapy: An exploratory study of in-session processes. Journal of Family Therapy, 34, 24–52.CrossRefGoogle Scholar
  34. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16. doi: 10.1037/a0022186 CrossRefPubMedGoogle Scholar
  35. Isserlin, L., & Couturier, J. (2012). Therapeutic alliance and family-based treatment for adolescents with anorexia nervosa. Psychotherapy, 49, 46–51.CrossRefPubMedGoogle Scholar
  36. Johnson, S. M., & Whiffen, V. E. (1999). Made to measure: Adapting emotionally focused couple therapy to partners’ attachment styles. Clinical Psychology: Science and Practice, 6, 366–381.Google Scholar
  37. Kerr, M. E., & Bowen, M. (1988). Family evaluation. New York: Basic Books.Google Scholar
  38. Knobloch-Fedders, L. M., Pinsof, W. M., & Mann, B. J. (2004). The formation of the therapeutic alliance in couple therapy. Family Process, 43, 425–442.CrossRefPubMedGoogle Scholar
  39. Knobloch-Fedders, L. M., Pinsof, W. M., & Mann, B. J. (2007). Therapeutic alliance and treatment progress in couple therapy. Journal of Marital and Family Therapy, 33, 245–257.CrossRefPubMedGoogle Scholar
  40. Lambert, J. E., & Friedlander, M. L. (2008). Relationship of differentiation of self to adult clients’ perceptions of the alliance in brief family therapy. Psychotherapy Research, 43, 160–166.CrossRefGoogle Scholar
  41. Lambert, J. E., Skinner, A., & Friedlander, M. L. (2012). Problematic within-family alliances in conjoint family therapy: A close look at five cases. Journal of Marital and Family Therapy, 38, 417–428.CrossRefPubMedGoogle Scholar
  42. Lebow, J. (2016). Integrative approaches to couple and family therapy. In T. L. Sexton & J. Lebow (Eds.), Handbook of family therapy (4th ed., pp. 205–227). New York: Routledge.Google Scholar
  43. Mamodhoussen, S., Wright, J., Tremblay, N., & Poitras-Wright, H. (2005). Impact of marital and psychological distress on therapeutic alliance in couples undergoing couple therapy. Journal of Marital and Family Therapy, 31, 159–169.CrossRefPubMedGoogle Scholar
  44. Muñiz de la Peña, C., Friedlander, M. L., & Escudero, V. (2009). Frequency, severity, and evolution of split family alliances: How observable are they? Psychotherapy Research, 19, 133–142.CrossRefPubMedGoogle Scholar
  45. Muñiz de la Peña, C., Friedlander, M. L., Escudero, V., & Heatherington, L. (2012). How do therapists ally with adolescents in family therapy? An examination of relational control communication in early sessions. Journal of Counseling Psychology, 59, 339–351.CrossRefGoogle Scholar
  46. Muran, J. C., Safran, J. D., Gorman, B. S., Samstag, L. W., Eubanks-Carter, C., & Winston, A. (2009). The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders. Psychotherapy: Theory, Research, Practice, Training, 45, 233–248.CrossRefGoogle Scholar
  47. Patterson, G. R., & Forgatch, M. S. (1985). Therapist behavior as a determinant for noncompliance: A paradox for the behavior modifier. Journal of Consulting and Clinical Psychology, 53, 846–851.CrossRefPubMedGoogle Scholar
  48. Pinsof, W. B. (1995). Integrative problem-centered therapy. New York: Basic Books.Google Scholar
  49. Pinsof, W. B., & Catherall, D. R. (1986). The integrative psychotherapy alliance: Family, couple and individual therapy scales. Journal of Marital and Family Therapy, 12, 137–151.CrossRefGoogle Scholar
  50. Pistole, M. C. (1989). Attachment in adult romantic relationships: Style of conflict resolution and relationship satisfaction. Journal of Social and Personal Relationships, 6, 505–510.CrossRefGoogle Scholar
  51. Rait, D. (2000). The therapeutic alliance in couples and family therapy. Journal of Clinical Psychology, 56, 211–224.CrossRefPubMedGoogle Scholar
  52. Robbins, M. S., Liddle, H. A., Turner, C. W., Dakof, G. A., Alexander, J. F., & Kogan, S. M. (2006). Adolescent and parent therapeutic alliances as predictors of dropout in multidimensional family therapy. Journal of Family Psychology, 20, 108–116.CrossRefPubMedGoogle Scholar
  53. Robbins, M. S., Turner, C. W., Alexander, J. F., & Perez, G. A. (2003). Alliance and dropout in family therapy for adolescents with behavior problems: Individual and systemic effects. Journal of Family Psychology, 17, 534–544.CrossRefPubMedGoogle Scholar
  54. Safran, J. D., Crocker, P., McMain, S., & Murray, P. (1990). Therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy, 27, 154–165.CrossRefGoogle Scholar
  55. Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford Press.Google Scholar
  56. Santisteban, D. A., Szapocznik, J., Perez-Vidal, A., Kurtines, W. M., Murray, E. J., & LaPerriere, A. (1996). Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology, 10, 35–44.CrossRefGoogle Scholar
  57. Sheehan, A. S., & Friedlander, M. L. (2015). Therapeutic alliance and retention in Brief Strategic Family Therapy: A mixed-methods study. Journal of Marital and Family Therapy, 41, 415–427.CrossRefPubMedGoogle Scholar
  58. Sluzki, C. E. (1992). Transformations: A blueprint for narrative changes in therapy. Family Process, 31, 217–230.CrossRefPubMedGoogle Scholar
  59. Smerud, P. E., & Rosenfarb, I. S. (2008). The therapeutic alliance and family psychoeducation in the treatment of schizophrenia: An exploratory prospective change process study. Journal of Consulting and Clinical Psychology, 76, 505–510.CrossRefPubMedGoogle Scholar
  60. Symonds, D., & Horvath, A. O. (2004). Optimizing the alliance in couple therapy. Family Process, 43, 443–455.CrossRefPubMedGoogle Scholar
  61. Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). New York: Routledge.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Valentín Escudero
    • 1
  • Myrna L. Friedlander
    • 2
  1. 1.University of A CoruñaA CoruñaSpain
  2. 2.University at Albany/SUNYAlbanyUSA

Personalised recommendations