The Therapeutic Alliance in Family Therapy

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Table of Contents

Abstract
The family
Therapeutic alliances
Therapeutic alliances for drug-abusing adolescents
Family therapeutic alliances: challenges and realizing balance
Conclusion
References

Abstract

Family constitutes an entity that binds related people together. As a result, solution to community and societal problems can be solved appropriately when carried within the family. Due to the important members within a family derive by being part of the family, it has been noted that effective individual therapy can exhibit positive outcomes when family members are involved in therapeutic process.

Thus, the therapeutic alliance in family therapy has emerged as an intervention method that integrates participation and collaboration of family members and therapist in treatment of various problems members of the family may be facing. Success of therapeutic alliance depends on the therapist and the family members, whereby, it is always suggested that efforts should be made to integrate family elements and therapists’ aspects in a more productive way that will enhance success of the treatment process.

Throughout this research, treatment of adolescents abusing drugs is evaluated using therapeutic alliances in family therapy. The aim is to evaluate challenges that in most cases, suffocate the therapeutic process and subsequently, how the therapist can ensure success of treatment is realized.

The process of achieving the goals here starts by looking at what a family is and what is meant by the therapeutic alliance. This is followed by highlighting the therapeutic alliance for drug-abusing adolescents, before finally looking at the therapeutic alliance challenges and ways of addressing the challenges.

The family

A family may be perceived and regarded as a composition of individuals who collectively share specific physical and psychological space. Family has been described in majority of literatures to exhibit diversity and complexities, aspects that have been necessitated by the rapidly changing modern society (Goldenberg and Goldenberg, 2008).

One observation is the fact that family represents and manifests multiplicity of cultural heritages, each considered to have a natural and social sustaining system. It is a sustaining social system in the way that it has its unique set of rules, as well as defined, assigned, and ascribed roles for its members.

In addition, it manifests and operates under an organized power structure where both overt and covert forms of communication exist. Moreover, it has its own unique ways of negotiating and resolving problems affecting the members (Goldenberg and Goldenberg, 2008).

What is ordinarily evident in many families is that, individuals within the family are normally tied to each other, relationships that turn out to be very powerful, durable, reciprocal, and also with strong emotional attachment. Although these ties may decrease or deteriorate over time, especially in terms of intensity and psychology, the fact is that they remain and persist within the entity of any family.

Numerous factors affect and influence the existence of a family, such as, cultural, social, and economic factors, together with emotional and psychological factors (Goldenberg and Goldenberg, 2008). These factors, together with others, influence the family system of development in terms of beliefs, standard behavior, developmental challenges, crises, and adaptability of the family.

Therapeutic alliances

Therapy is a practice that has become part of the family, since family is not immune to problems that may affect it. In carrying out therapy, professionals (therapists) always act as outsiders to the family, where in most cases they lack knowledge about the complex and often-dysfunctional rules of families.

In order to get acceptance and effectively administer therapy to family members, there is always need to alter or modify some aspects that characterize the family (Glick, Berman, and Clarkin, 2000). Therapy is a process whose intentions and goals are premised on the desire to see dysfunctional family changed and improved in the positive way. These basic desires call for therapists to strive and inject concerted efforts in their work to realize meaningful results.

As a result, it has been established that success in any therapeutic process requires an environment in which those concerned and affected by the therapeutic process establish and maintain open, trusting, and collaborative relationships or alliances (Glick, Berman, and Clarkin, 2000). Collaborative partnerships in these situations provide opportunity for successful realization of corrective experiences that later lead to meaningful changes.

Therapeutic alliances used in therapy have been discovered to be the best and appropriate means or mechanisms of psychotherapy outcome in individual therapy as well as family therapy (Glick, Berman, and Clarkin, 2000).

Therapeutic alliances function on the goals of collaboration and in most cases, they are associated with impacting hope in the family (Glick, Berman and Clarkin, 2000). More so, they enable a safer environment for the family to modify its behaviors and subsequently engage in new behaviors that can improve functioning of the family.

Therapeutic alliances for drug-abusing adolescents

Research has been done on the way adolescents abusing drugs are difficult to engage in successful treatment (Kazdin, Stolar and Marciano, 1995 cited in Flicker, Turner, Waldron, Brody and Ozechowski, 2008). Nevertheless, even within this difficulty, numerous treatment therapeutic models have been developed with an attempt to treat the drug abuse problems among the adolescents.

As a result, there exist different ways and settings in which adolescents’ therapy can take place, which in most cases include outpatient treatment, inpatient treatment, long-term residential treatment, specialized therapeutic communities and self-help treatments (Liddle and Rowe, 2006).

Application of any of the stated treatment approach usually has to put into consideration the fact that adolescents’ problem of drug abuse is a relatively long term issue that will need treatment approach that aims to help the affected adolescent over a prolonged period of time.

In treating adolescent drug abuse problem, there has been suggestion for specific procedural to be followed. First, the treatment has to be adaptive to the needs of the individual adolescent with regard to the context in which the individual adolescent is.

Second, the treatment needs to be developmentally appropriate in that the level of adolescent development stage need to be factored in. Lastly, the treatment needs to be culturally appropriate for the needs of adolescents (Liddle and Rowe, 2006).

Family treatment has slowly but gradually obtained prominence in treating adolescents’ drug abuse problems. According to numerous researches that have been undertaken in this area, it has been revealed that family therapeutic approaches have evolved to become productive and superb ways of achieving abstinence while at the same time contributing to reduction of risk factors and improving protective factors (Liddle and Rowe, 2006).

Given that family therapy is becoming popular, it has been suggested that one important aspect to cultivate in family therapy approach is to ensure development of a close parent-child mutual attachment relationship (Liddle and Rowe, 2006). Development of close ties with parents is perceived to be essential in leading to realization of positive reinforcement that encourages positive behaviors.

Advocacy for family therapy based strategies has led to development and promotion of therapeutic alliance relationships in the treatment of adolescents’ drug abuse. Meta-analyses that have been conducted by numerous researchers have found that the role of therapeutic alliances is critical and vital in psychotherapy outcomes (Martin, Garske, and Davis, 2000, cited in Flicker, Turner, Waldron, Brody, and Ozechowski, 2008).

However, in initiating therapeutic alliances, therapists are advised to initiate different conceptualization of family therapeutic alliances as opposed to individual therapeutic partnerships. In this way, it is anticipated that managing different relationships within the family on the part of the therapist will be possible.

Mono-directional relationships are considered unsuccessful if the therapist adopts this, and may lead to unbalanced alliances (Flicker, Turner, Waldron, Brody and Ozechowski, 2008). Consequently, the presence of unbalanced alliances may result into poor initiation and retention of therapy.

Family therapeutic alliances: challenges and realizing balance

Challenges

The decision by a family therapist to engage the family in the treatment of drug abuse adolescents may not be successful specifically when certain key aspects are subtracted from the entire process of therapeutic alliance formulation. In cases where failure is witnessed, numerous factors both present in the family and exhibited by the therapist have been identified to contribute to this failure.

When therapeutic alliance process fails, there is normally the emergence of imbalance with regard to the family therapy, which in turn aids to dropout of adolescents from the therapeutic process (Flicker, Turner, Waldron, Brody, and Ozechowski, 2008). What are some of the elements that a family therapist has to contend within the context of the family? Glick, Berman, and Clarkin (2000) observe that families have different people who are quite different in terms of feelings and agenda and this normally affect family therapy.

At the same time, the therapist usually comes to realization that the existence of numerous interactive systems in the family brings typically about difficult in choosing the appropriate conceptual framework of family therapy process.

As these forces of complex in the family become manifested, the therapist generally finds the process of inducting in the family system to be difficult since the general perception is that, the therapist is totally an outsider (Glick, Berman and Clarkin, 2000).

Furthermore, the family has people with differing motivations, goals, and beliefs that in most cases, therapists find it difficult to appropriately integrate these aspects with less resistance.

In general, therapeutic alliance challenges can be sub-divided into three: mismatch between therapist and family, disagreement as to treatment goals and inability of therapist to recognize inclusion in the system of members perceived not to be part of the nuclear family (Glick, Berman, and Clarkin, 2000).

Mismatch between the family and therapist may be evidenced in situations such as family members perceiving the therapist to be inappropriate to their needs, and the therapist style of operating being totally detached from the family members’ needs.

With regard to disagreement as to treatment goals, clash may arise due to presentation of differing goals between the therapist and the family, which may eventually suffocate treatment process.

Inclusion of extended members of the family into the treatment process may be a desire in some families, but the therapist may tend to recognize and appreciate their presence hence the entire treatment process may be stalled (Glick, Berman and Clarkin, 2000).

How to realize success

The presence of challenges and their overall impact on the treatment process should not constitute reasons to stall the entire process of treatment. Numerous methods have been proposed in which the therapeutic alliance can be made successful. Researches have shown that meaningful and beneficial therapeutic alliances result from the first steps of the therapist in establishing a well-define structure within which family intervention is likely to occur (Glick, Berman and Clarkin, 2000).

In working with drug-abusing adolescents, Stanton and Todd (1981) formulated the success guiding principles, which a therapist needs to adopt to realize success (Glick, Berman and Clarkin, 2000). In the first place, the therapist is required to decide which particular members will be part of the treatment and this is followed by request and encouragement on the members to attend to an evaluation interview (Glick, Berman, and Clarkin, 2000).

Thereafter, the therapist should see to it that the drug addict adolescent is not given the responsibility to bring in family members; instead, the therapist should obtain permission from the adolescent to contact the family members.

After the initial process of contacting family members has been fulfilled, the therapist then should reveal the rationale of intervention to the family members. In its nature, the intervention suggested to the family members should be non-pejorative and nonjudgmental whereby, blame should not be heaped on family members for problems affecting the adolescent (Glick, Berman and Clarkin, 2000).

Conclusion

When compared to individual therapeutic alliance, the family therapeutic alliance appears to be complicated and every effort needs to be made in understanding the whole entity of the family with regard to therapeutic process. Within family members, there are manifested different behaviors in terms of commitment, understanding, and the will to change, and all these aspects combine to make the process of therapeutic alliance in family therapy more complex.

Nevertheless, in order to succeed in the intervention and treatment process, the therapist needs to cultivate skills of listening, effective communication and expression, respect of the members, less negative comments and ability to capture members perspective, all of which function to increase security of the members, hence being more willing to participate in treatment process.

References

Flicker, S. M., Turner, C. W, Waldron, H. B., Brody, J. L. and Ozechowski, T. J. (2008). Ethnic background, therapeutic alliance, and treatment retention in functional family therapy with adolescents who abuse substances. Journal of Family Psychology, Vol. 22, No. 1, pp. 167-170.

Glick, I. D., Berman, E. M. and Clarkin, J. F. (2000). Marital and Family Therapy. VA: American Psychiatric Publishing.

Goldenberg, H. and Goldenberg, I. (2008). Family therapy: an overview. OH: Cengage Learning.

Liddle, H. A. and Rowe, C. L. (2006). Adolescent substance abuse: research and clinical advances. London: Cambridge University Press.

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