title: Alliance in couple and family therapy.
abstract: Couple and family therapy (CFT) is challenging because multiple interacting working alliances develop simultaneously and are heavily influenced by preexisting family dynamics. An original meta-analysis of 24 published CFT alliance-retention/outcome studies (k = 17 family and 7 couple studies; N = 1,416 clients) showed a weighted aggregate r = .26, z = 8.13 (p < .005); 95% CI = .33, .20. This small-to-medium effect size is almost identical to that reported for individual adult psychotherapy (Horvath, Del Re, Flückiger, & Symonds, this issue, pp. 9-16). Analysis of the 17 family studies (n = 1,081 clients) showed a similar average weighted effect size (r = .24; z = 6.55, p < .005; 95% CI = .30, .16), whereas the analysis of the 7 couple therapy studies (n = 335 clients) indicated r = .37; z = 6.16, p < .005; 95% CI = .48, .25. Tests of the null hypothesis of homogeneity suggested unexplained variability in the alliance-outcome association in both treatment formats. In this article we also summarize the most widely used alliance measures used in CFT research, provide an extended clinical example, and describe patient contributions to the developing alliance. Although few moderator or mediator studies have been conducted, the literature points to three important alliance-related phenomena in CFT: the frequency of "split" or "unbalanced" alliances, the importance of ensuring safety, and the need to foster a strong within-family sense of purpose about the purpose, goals, and value of conjoint treatment. We conclude with a series of therapeutic practices predicated on the research evidence.
authors.affiliation: Department of Educational and Counseling Psychology, University at Albany/State University of New York, 1400 Washington Avenue, Albany, NY 12222, USA. mfriedlander@uamail.albany.edu
authors.forename: Myrna L
authors.initials: ML
authors.lastname: Friedlander
authors.forename: Valentín
authors.initials: V
authors.lastname: Escudero
authors.forename: Laurie
authors.initials: L
authors.lastname: Heatherington
authors.forename: Gary M
authors.initials: GM
authors.lastname: Diamond
mesh_terms: D000293:Adolescent; D003299:Cooperative Behavior; D019546:Couples Therapy / Q000379:methods*; D005196:Family Therapy / Q000379:methods*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011369:Professional-Patient Relations; D016896:Treatment Outcome