Alliance in Couple and Family Therapy

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 twenty-four published CFT alliance-retention/outcome studies (k =17 family and 7 couple studies; N = 1,416 clients) showed a weighted aggregate r = .26. This medium effect size is almost identical to that reported for individual adult psychotherapy. In this chapter, 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 available 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.