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Review
. 2018 Jun;21(2):146-170.
doi: 10.1007/s10567-017-0249-y.

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis

M J Welmers-van de Poll  1   2 , J J Roest  3 , T van der Stouwe  4 , A L van den Akker  4 , G J J M Stams  4 , V Escudero  5 , G J Overbeek  4 , J J W de Swart  6
Affiliations
Review

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis

M J Welmers-van de Poll et al. Clin Child Fam Psychol Rev. 2018 Jun.

Abstract

Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies. However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance-outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance-outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N = 2126 families, M age youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of the associations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r = .281, p = .067), and no significant correlation was found between split alliances and treatment outcome (r = .106, p = .343). However, the number of included studies reporting on alliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.

Keywords: Family-based treatment; Multilevel meta-analysis; Therapeutic alliance; Treatment outcomes; Working alliance.

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Conflict of interest statement

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Ethics Review Board of the Faculty of Social and Behavioral Sciences, University of Amsterdam.

Figures

Fig. 1
Fig. 1
Flow diagram for the search and identification of studies
Fig. 2
Fig. 2
Trim-and-fill plot level of alliance–outcome association
Fig. 3
Fig. 3
Trim-and-fill plot split alliance–outcome association
Fig. 4
Fig. 4
Trim-and-fill plot alliance change score–outcome association
See this image and copyright information in PMC

References

    1. Assink M, Van der Put CE, Hoeve M, De Vries SLA, Stams GJJM, Oort FJ. Risk factors for persistent delinquent behavior among juveniles: A meta-analytic review. Clinical Psychology Review. 2015;42:47–61. doi: 10.1016/j.cpr.2015.08.002. - DOI - PubMed
    1. Assink M, Wibbelink CM. Fitting three-level meta-analytic models in R: A step-by-step tutorial. The Quantitative Methods for Psychology. 2016;12:154–174. doi: 10.20982/tqmp.12.3.p154. - DOI
    1. Bachler E, Frühmann A, Bachler H, Aas B, Strunk G, Nickel M. Differential effects of the working alliance in family therapeutic home-based treatment of multi-problem families. Journal of Family Therapy. 2016;38(1):120–148. doi: 10.1111/1467-6427.12063. - DOI
    1. Bartle-Haring S, Glebova T, Gangamma R, Grafsky E, Delaney RO. Alliance and termination status in couple therapy: A comparison of methods for assessing discrepancies. Psychotherapy Research. 2012;22(5):502–514. doi: 10.1080/10503307.2012.676985. - DOI - PubMed
    1. Bennun I. Perceptions of the therapist in family therapy. Journal of Family Therapy. 1989;11:243–255. doi: 10.1046/j..1989.00350.x. - DOI

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