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Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

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Abstract

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.

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References

  • Azrin, N. H., Donohue, B., Besalel, V. A., Kogan, E. S., & Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child and Adolescent Substance Abuse, 3(3), 3–15

    Article  Google Scholar 

  • Bachelor, A. (1995). Clients’ perceptions of the therapeutic alliance: A qualitative analysis. Journal of Counseling Psychology, 42(3), 323

    Article  Google Scholar 

  • Beck, M., Friedlander, M. L., & Escudero, V. (2006). Three perspectives on clients’ experiences of the therapeutic alliance: A discovery-oriented investigation. Journal of Marital and Family Therapy, 32(3), 355–368

    Article  PubMed  Google Scholar 

  • Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, Ttheory, Research and Practice, 16(3), 252–260

    Google Scholar 

  • Broome, K. M., Joe, G. W., & Simpson, D. D. (2001). Engagement models for adolescents in DATOS-A. Journal of Adolescent Research, 16(6), 608–610

    Article  Google Scholar 

  • Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313–327

    Article  PubMed  Google Scholar 

  • Cunningham, P. B., & Henneggler, S. W. (1999). Engaging multiproblem families in treatment: Lessons learned throughout the development of multisystemic therapy. Family Process, 38(3), 265–281

    Article  PubMed  Google Scholar 

  • Dearing, R. L., Barrick, C., Dermen, K. H., & Walitzer, K. S. (2005). Indicators of client engagement: Influences on alcohol treatment satisfaction and outcomes. Psychology of Addictive Behaviors, 19(1), 71–78

    Article  PubMed  Google Scholar 

  • Diamond, G. S., & Liddle, H. A. (1999). Transforming negative parent-adolescent interactions: From impasse to dialogue. Family Process, 38(1), 5–26

    Article  PubMed  Google Scholar 

  • Diamond, G. M., Liddle, H. A., Hogue, A., & Dakof, G. A. (1999). Alliance-building interventions with adolescents in family therapy: A process study. Psychotherapy, 36(4), 355–368

    Google Scholar 

  • Digiuseppe, R., Linscott, J., & Jilton, R. (1996). Developing the therapeutic alliance in child-adolescent psychotherapy. Applied and Preventive Psychology, 5(2), 85–100

    Article  Google Scholar 

  • Eltz, M. J., Shirk, S. R., & Sarlin, N. (1995). Alliance formation and treatment outcome among maltreated adolescents. Child Abuse and Neglect, 19(4 (Print)), 419–431

    Article  PubMed  Google Scholar 

  • Friedlander, M. L., Horvath, A. O., Cabero, A. S., Escudero, V., Heatherington, L., & Martens, M. P. (2006). System for observing family therapy alliances: A tool for research and practice. Journal of Counseling Psychology, 53(2), 214–225

    Article  Google Scholar 

  • Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139

    Article  Google Scholar 

  • Hougaard, E. (1994). The therapeutic alliance—a conceptual analysis. Scandinavian Journal of Psychology, 35, 67–85

    PubMed  Google Scholar 

  • Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26(1), 50–65

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65(3), 453–463

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Marciano, P. L., & Whitley, M. K. (2005). The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior. Journal of Consulting and Clinical Psychology, 73(4), 726–730

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: Methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44(8), 1116–1129

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Siegel, T. C., & Bass, D. (1990). Drawing on clinical practice to inform research on child and adolescent psychotherapy: Survey of practitioners. Professional Psychology: Research and Practice, 21(3), 189–198

    Article  Google Scholar 

  • Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S. M., Hoven, W. E., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 889–897

    Article  PubMed  Google Scholar 

  • Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejeda, M. (2001). Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse, 27(4), 651–688

    Article  PubMed  Google Scholar 

  • Martin, J., Romas, M., Medford, M., Leffert, N., & Hatcher, S. L. (2006). Adult helping qualities preferred by adolescents. Adolescence, 41(161), 127–140

    PubMed  Google Scholar 

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage, Publications

    Google Scholar 

  • Patton, M. Q. (2001). Qualitative evaluation and research methods (3rd ed.). Newbury Park: Sage Publications

    Google Scholar 

  • Pinsof, W. M., Horvath, A. O., & Greenberg, L. S. (1994). An integrative systems perspective on the therapeutic alliance: Theoretical, clinical, and research implications. In A. O. Horvath, & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice. (pp. 173–195). New York: Wiley

    Google Scholar 

  • Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2005). Adolescent and parent alliance and treatment outcome in multidimensional family therapy. Journal of Consulting and Clinical Psychology, 73(4), 689–698

    Article  PubMed  Google Scholar 

  • Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71(3), 452

    Article  PubMed  Google Scholar 

  • Spoth, R., Redmond, C., Hockaday, C., & Shin, C. Y. (1996). Barriers to participation in family skills preventive interventions and their evaluations. Family Relations, 45(3), 247–255

    Article  Google Scholar 

  • Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin, 122(2), 170–191

    Article  PubMed  Google Scholar 

  • Thomas, M. L. (2006). The contributing factors in a therapeutic process. Contemporary Family Therapy, 28, 201–210

    Article  Google Scholar 

  • Thompson, S. J., Pollio, D., Eyrich, K., Bradbury, E., & North, C. S. (2004). Successfully exiting homelessness: Experiences of formerly homeless mentally ill individuals. Evaluation and Program Planning, 27(4), 423–431

    Article  Google Scholar 

  • Waldron, H. B. (1997). Adolescent substance abuse and family therapy outcome: A review of randomized trials. Advances in Clinical Child Psychology, 19, 199–234

    Google Scholar 

  • Waldron, H. B., Slesnick, N., Brody, J. L., Turner, C. W., & Peterson, T. R. (2001). Treatment outcomes for adolescent substance abuse at 4 and 7 month assessment. Journal of Consulting and Clinical Psychology, 69(5), 802–813

    Article  PubMed  Google Scholar 

  • Wang, M-N, Sandberg, J., Zavada, A., Mittal, M., Gosling, A., Rosenberg, T., et al. (2006). “Almost there”...Why clients fail to engage in family therapy: An exploratory study. Contemporary Family Therapy, 28(2), 211–224

    Article  Google Scholar 

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Acknowledgment

This manuscript was supported in part by a Career Development Award (K01-DA015671) from the National Institute of Drug Abuse to Dr. Thompson.

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Correspondence to Sanna J. Thompson.

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Thompson, S.J., Bender, K., Lantry, J. et al. Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families. Contemp Fam Ther 29, 39–55 (2007). https://doi.org/10.1007/s10591-007-9030-6

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  • DOI: https://doi.org/10.1007/s10591-007-9030-6

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