Therapeutic alliance is a widely researched topic in psychotherapy literature due to its positive relationship with treatment outcome. Recently, researchers have started to address therapeutic alliance in couple and family therapy, but have struggled to identify the essential elements and therapist and client behaviors that are influential of positive alliance formation with multiple family members. Review of the literature shows that research needs to measure alliance over time in order to see how it evolves in conjoint therapy, and needs to incorporate the four perspectives of alliance: the therapist, each member of the couple, and independent observer. This study adopted a process oriented approach to explore therapeutic alliance formation and maintenance with couples. Two doctoral level therapists were followed over the course of treatment with a total of 5 couples. Data were collected through semi-structured interviews and SOFTA (Friedlander, Escudero, & Heatherington, 2006a) observational and self-report measures to identify key themes and patterns of alliance development based on the experiences of each member of the therapeutic system and an independent observer. Thematic content analysis of the interview data identified that therapeutic factors pertaining to the training nature of the clinic and student status of the therapists had initial negative influences on the alliance formation. Additionally, findings suggested that the client factors related to level of relationship distress, interpersonal skills and gender contributed to the formation and progression of alliance over the course of therapy. Therapist characteristics such as personality and gender, as well as the interactive factors related to the couple-therapist goodness of fit and therapist skills also influenced the therapeutic relationship. The results from the SOFTA self-report data identified how alliance progressed throughout treatment for each couple. Alliance configurations depicted alliance patterns that stabilized around the fourth session followed by increased fluctuations after the sixth sessions. Overall, therapeutic alliance patterns were most heavily influenced by the level of relationship distress and strength of the within-couple alliance. How well therapists promoted individual alliances with both partners and the within-couple alliance contributed to the alliance ratings.The results of the study have important implications for the effective formation and management of alliance with couples. Discussion of the findings connects previous research to the current results to provide a greater understanding of how therapeutic alliance was formed with the couples in this study. Clinical and training implications are given for supervisors and therapists working with couples, as well as suggestions for future research on therapeutic alliance formation and management with couples.
Read
