Dropout Versus Retention in Family Therapy: How are they Associated with Behavioral Manifestations of the Therapeutic Alliance?

This retrospective observational study aimed to examine the expanded therapeutic alliance in relation to drop out versus retention in systemic family therapy. Forty cases randomly selected from archived records at a university center for family therapy were identified as either dropouts (n = 13) or completers (n = 27). Videotapes of all first sessions were rated using the system for observing family therapy alliances by two trained judges. Identification of the alliance-related behaviors exhibited by clients and therapists in these sessions showed that compared to completed cases, dropout cases had significantly weaker clients' alliances as well as more severely split alliances. Moreover, the three most critical dimensions of the alliance in relation to termination status were client engagement in the therapeutic process, a felt sense of safety within the therapeutic context, and the family's shared sense of purpose about the needs, goals and value of therapy (i.e. the within system-alliance). These findings are consistent with other research that established an association between the therapeutic alliance and treatment retention in family therapy. Clinical implications for addressing the alliance threats in the first session are discussed along with specific recommendations for alliance training.