Client growth and alliance development in solution-focused brief family therapy
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There has been an urgent need for more outcome and process research on solution-focused brief therapy (SFBT). The review of literature revealed particularly the lack of the study on the application of SFBT to difficult children in a joint family session, several methodological issues related to the research design, and no exploration of treatment process of SFBT. The purposes of this study were: (a) to provide evidence of treatment outcome of SFBT by measuring client change as a result of family treatment, (b) to explore the process of client change and alliance development in SFBT that is considered as one of the most important process variables, and (c) to examine the relations between family alliances and therapy outcome and the role of multiple alliances in family therapy. Participants were the families with difficult children who have school- and home-related behavioral concerns. Of the 113 families treated in a public school-based family clinic, 25 families including a total of 82 individuals were selected based on the following criteria: (a) the families attended at least four family sessions, (b) the families included a minimum of one parent and one child, and (c) the families reported the weekly based growth and alliance scores. The analysis was conducted in several steps. First, overall therapy outcome was examined. Therapy outcome was measured as the changes between client's pre- and post growth ratings, and the result indicated significant differences in three data levels (i.e., family, children, and parents-level). The effect sizes were 1.37, .88, and .59 for the family, children, and parents, respectively, which indicates that therapy outcome in family-level is larger than in individual-level. No significant difference in therapy outcome was found between parents and children. A series of repeated measures ANOVA and ANCOVA tests revealed that overall the level of client growth and alliance significantly improved over time. There was no significant difference between parents and children at any level of growth and alliance across time. Thus, no separate alliance (i.e., unbalanced alliance) seems to exist between parents and children. Multidimensional scaling analysis demonstrated different patterns of growth and alliance development between family, parents, and identified children. Parents established more rapid growth and alliance, which subsequently remained stable, whereas children showed a slow but continuously improving pattern of growth and alliance. Implications and limitations of the study are discussed.