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    Escudero 2016 Journal of Family Therapy

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    Escudero 2016 Journal of Family Therapy

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    Escudero 2016 Journal of Family Therapy

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    net/publication/291553595

    Guest editorial: the therapeutic alliance from a systemic perspective

    Article  in  Journal of Family Therapy · February 2016


    DOI: 10.1111/1467-6427.12110

    CITATIONS READS

    8 156

    1 author:

    Valentín Escudero
    University of A Coruña
    74 PUBLICATIONS   1,480 CITATIONS   

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    Some of the authors of this publication are also working on these related projects:

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

    Alliance and Outcome in Family Therapy: a Three Level Meta-Analysis View project

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    Journal of Family Therapy (2016) 38: 1–4
    doi: 10.1111/1467-6427.12110

    Editorial

    Guest editorial: the therapeutic alliance from a


    systemic perspective

    Valentın Escudero

    The therapeutic alliance is undoubtedly the most robust of the many


    relationship factors that account for change in successful psychother-
    apy (Horvath, Del Re, Fl} uckiger and Symonds, 2011). This evidence
    is equally applicable to conjoint family therapy (Friedlander, Escu-
    dero, Heatherington and Diamond, 2011), although the amount of
    research on the alliance in family therapy is not comparable to indi-
    vidual psychotherapy.
    The alliance is considered a conjoint product of both therapist and
    client(s), basically a product of interactions in the therapeutic context.
    In his classical definition, Bordin (1979) defined the alliance in indi-
    vidual psychotherapy as composed of three elements: bonds (the
    affective quality of the therapist-client relationship, which includes
    trust and care); tasks (the agreement between client and therapist on
    the tasks of therapy); and goals (the extent to which client and thera-
    pist work together in order to achieve negotiated goals). Regardless
    of quantitative estimates on the impact of the alliance on therapy out-
    comes, research results confirm that, regardless of the therapeutic
    approach, strong evidence indicates that the therapeutic alliance
    established early in therapy can predict treatment retention and the
    ultimate outcome. On the other hand, process research indicates also
    that ruptures, defined as deteriorations in the quality of the alliance,
    occur frequently regardless of therapeutic approach, and their suc-
    cessful ‘repair’ seems to be relevant for predicting successful out-
    comes (Escudero et al., 2012).
    Building the alliance in family therapy is, as often as not, an intri-
    cate and fascinating challenge, as demonstrated by the series of

    Accompanying podcast for Journal of Family Therapy, Volume 38, Issue 1 is available at
    https://www.youtube.com/watch?v5xXiHYwL3Z6c

    C 2015 The Association for Family Therapy and Systemic Practice


    V
    2 Editorial
    articles included in this special issue. One of the distinguishing char-
    acteristics of systemic therapies is the application of a relational per-
    spective on symptoms and problems. This perspective logically leads
    to an interest in working with all parties simultaneously; consequently
    the therapeutic context tends to be a multi-actor setting. The implica-
    tion of this formulation of the therapy is that the therapeutic alliance
    is indeed a dynamic set of alliances. In the words of Sprenkle and Blow
    (2004), a common factor of family therapy is the ‘expanded therapeu-
    tic alliance’. For this reason it can be said that the therapeutic alliance
    in conjoint family therapy reflects a unique set of conceptual and clin-
    ical features and, therefore, requires a distinct field of research. The
    mere presence of more than one client in the session, especially when
    family members are at different developmental levels, results in a
    higher level of complexity for creating and maintaining the alliance.
    Moreover, conflicting motives and ambivalence about participating in
    the therapy usually involve the entire family, especially in the context
    of involuntary clients, that is, when treatment is initiated under pres-
    sure from the school, child protective services, or powerful subsys-
    tems in the family. Additionally, it is essential to understand that the
    ‘client’ in family therapy is not merely a collection of people but
    rather a system with a specific history and a particular kind of inter-
    personal/relational dynamics. As the therapeutic alliance involves cre-
    ating relational connections and ensuring safety, attachment style is
    one of the many significant factors that need to be considered in
    order to fully understand the process of building and maintaining
    multiple therapeutic alliances simultaneously.
    A systemic perspective on the therapeutic alliance is based on a
    perspective of the alliance as a plural and multidimensional phenom-
    enon. That is, alliances develop not only between individuals and the
    therapist, but also between the couple or family as a system and the
    therapist, between subsystems (e.g., parents) and the therapist, and
    within the family system (the internal alliance between members of
    the family regarding the process of therapy). Researching how these
    multiple alliances interact systemically is the primary challenge for
    family therapy practice. Although research on the alliance from a sys-
    temic perspective is still scarce, its creativity and rigour foreshadow a
    fertile, productive future development.
    In this issue we are publishing a series of articles exploring quite
    different aspects of the alliance, from qualitative as well as quantitative
    perspectives, and including couple as well as adolescent and family
    treatments. The first article, by Yoo et al., is an analysis of videotape

    C 2015 The Association for Family Therapy and Systemic Practice


    V
    Editorial 3
    recordings of two samples of couples in therapy – one in the first ses-
    sion and the other in the third session – to examine the association
    between alliance and termination status. Findings show the strong
    influence of the alliance in the first sessions, indicating that therapists
    in training need to pay particular attention to their alliance with cli-
    ents from the very beginning of therapy. Halford et al. examined the
    association between men’s and women’s pre-therapy relationship
    adjustment and alliance at session one and over the course of therapy.
    Results show that partners’ pre-therapy relationship distress can neg-
    atively influence early alliance establishment, thus indicating that
    more attention to the alliance may be needed for more distressed cou-
    ples. Sotero et al. compared involuntary and voluntary clients in the
    establishment of the therapeutic alliance in the context of brief family
    therapy; this study is based on an observational evaluation of the alli-
    ance in sessions one and four from videotapes of forty families.
    Results indicated that the clients who sought therapy voluntarily dem-
    onstrated more alliance-related behaviour than did involuntary cli-
    ents in the first session but not in the fourth session; these results
    provide useful ideas to promote and monitor the therapeutic alliance
    with involuntary clients.
    The next two articles connect the therapeutic alliance with attach-
    ment styles. The results of Yusof and Carpenter’s qualitative study
    show that secure and insecure therapists, in terms of their adult
    attachment style, differed on one dimension of the alliance – emo-
    tional connections to family members – suggesting that the ability to
    co-create a secure base may be related to the therapist’s adult attach-
    ment style. The findings of Feder and Diamond’s study show that the
    strength of the parent-therapist alliance predicted parents’ subse-
    quent attachment-promoting behaviour, although their attachment-
    promoting behaviour did not predict post-treatment outcomes in the
    context of attachment-based family therapy for suicidal and
    depressed adolescents.
    The final three articles are quite different in their aims and meth-
    odology. Muntigl and Horvath used conversation analysis for a micro-
    analysis of the interactional practices of Salvador Minchin in a
    disaffiliative episode at the very beginning of a therapy session. The
    authors interpreted this analysis as an illustration of how a therapist
    can disagree with clients’ position without generating stress or a rup-
    ture in the alliance. Bachler et al.’s study is a pre/post naturalistic
    investigation of home-based therapeutic work with multi-problem
    families; results demonstrated that 379 families generally showed

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    V
    4 Editorial
    significant psychological improvement on ten scales reflecting
    patient–therapist collaboration, treatment expectancy and psycho-
    social outcome measures, emphasising that improving the working
    alliance and treatment expectancy is essential for increasing the qual-
    ity of treatment results. And Carmel Flaskas’s article closes this special
    issue, offering a set of elegant theory reflections nurtured by a pas-
    sionate view of the therapeutic potentials and challenges of therapeutic
    relating and the therapist’s use of self in family therapy.

    References
    Escudero, V., Boogmans, E., Loots, G. and Friedlander, M. L. (2012) Alliance
    rupture and repair in conjoint family therapy: an exploratory study. Psycho-
    therapy, 49: 26–37.
    Bordin, E. S. (1979) The generalizability of the psychoanalytic concept of the
    working alliance. Psychotherapy: Theory, Research, & Practice, 16: 252–260.
    Friedlander, M. L., Escudero, V., Heatherington, L. and Diamond, G. M. (2011)
    Alliance in couple and family therapy. Psychotherapy, 48: 25–33.
    Horvath, A. O., Del Re, C., Fl€uckiger, C. and Symonds, D. (2011) Alliance in indi-
    vidual psychotherapy. Psychotherapy, 48: 9–16.
    Sprenkle, D. H. and Blow, A. J. (2004) Common factors and our sacred models.
    Journal of Marital and Family Therapy, 30: 113–129.

    C 2015 The Association for Family Therapy and Systemic Practice


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