Alliance-building interventions with adolescents in family therapy: A process study

This exploratory, process-research study identified, articulated, and measured therapist behaviors associated with improving initially poor therapist-adolescent alliances in multidimensional family therapy (MDFT). A list of preliminary alliance-building interventions was generated from MDFT theory and adolescent development research. This list was then refined through the observation of videotaped MDFT sessions. A sample of five improved and five unimproved alliance cases was then drawn from a larger treatment study. Participants were primarily African American, male, adolescent substance abusers and their families. Coders rated the first three sessions of each case (30 sessions) to determine the extent to which each alliance-building intervention was employed. By session three, therapists were attending to the adolescent's experience, formulating personally meaningful goals, and presenting as the adolescent's ally more extensively in the improved alliance cases than in the unimproved alliance cases. Using these data, proposed stages of alliance building with adolescents are discussed.