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Book’s multicultural approach
is impressive
(January 2007 Issue)

“Therapeutic Alliances in Couple
and Family Therapy”
By Myrna L. Friedlander, Valentin Escudero,
and Laurie Heatherington
American Psychological Association
Washington, D.C., 2006

By Paul Efthim, Ph.D.

For psychologists interested in family therapy process research, a new book by Williams College psychology professor Laurie Heatherington offers an exciting new set of tools. "Therapeutic Alliances in Couple and Family Therapy: An Empirically Informed Guide to Practice" represents a state-of-the-art look at one of the most central questions for both practitioners and researchers: What makes for strong, durable alliances in our work with couples and families?

Together with psychologists Myrna Friedlander of SUNY-Albany and Valentin Escudero of Spain's University of Coruna, Heatherington tackles the challenge of analyzing the complexities of conjoint alliances by offering both observational and self-report measures to the research community. Their "System of Observing Family Therapy Alliances" was developed simultaneously in Spain and in the U.S. in conjunction with a counseling psychology graduate exchange program between the two nations. Several measures and rating systems in both English and Spanish are published in the book to encourage broader research and training.

The authors argue that there are four major variables that need to be measured regarding alliances: engagement with the therapy; emotional connection to the therapist; safety in the presence of other family members; and a shared sense of purpose within the family regarding the therapeutic enterprise. These last two factors differ from the more general "common factors" that have been identified in the large body of psychotherapy research that is overwhelmingly drawn from studies of one-to-one treatment alliances.

The book itself breaks into four major sections. After an introductory overview, there is a detailed and critical literature review on each of the four major elements, illustrated amply by clinical examples. The third section looks at special problems faced in forming alliances, such as working with mandated patients, dealing with split alliances, diversity issues within the alliance, and counter transference dilemmas. Lastly, the authors discuss implications for practice, teaching, supervision and research.

One gets an overall sense that this book embodies a new level of sophistication in family therapy research. The approach wisely integrates both qualitative and quantitative data analysis, and adopts a pragmatic approach that acknowledges the contributions from psychoanalytic, systems, behavioral and strategic schools of family work without forging an allegiance with any one method. Moreover, the authors deserve recognition for developing not only a paper-and-pencil set of measures but also an electronic version, all of which are available free of charge on their Web site (www.softa-soatif.net). It is invigorating to witness their eagerness to share these new tools with other researchers and students.

Praise is also due for the book's explicitly multicultural approach. This type of international and multilingual research collaboration is quite rare for American psychologists and is a major strength of this project.

Clinicians may find the book hard to access. In the first part of the book there is an unfortunate emphasis on dry, psychometric issues that no doubt will scare off some practitioners. This material would have been better contained in an appendix. There is some good clinical material in later sections but this volume may lose some readers who try to slog through the more technical stuff early on.

In addition to researchers, this book and its research tools would be highly recommended for training novice family and couple therapists.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds a faculty appointment at the Massachusetts School of Professional Psychology.