Negotiating therapeutic alliances with a family at impasse

To bridge the science-practice gap, the APA Presidential Task Force endorsed the publication of evidence-based case studies, but to date, there have been few such investigations of conjoint family therapy. To fill this gap, we studied a successful case of treatment-as-usual in a community agency. Owing to the complexity of the working alliance in conjoint therapy, we examined how an experienced family therapist managed to develop and sustain multiple alliances over time with an estranged couple in crisis. The outcome data showed clinically meaningful changes as well as high satisfaction levels and notable declines in the target complaint discomfort levels of all family members. Alliance indicators showed that the therapist worked diligently over time to connect emotionally with each family member and to foster and maintain safety. Session impact scores showed consistently deep sessions but more variability in smoothness. By working toward the only shared treatment goal-to repair each parent's individual relationship with their very angry daughter-the therapist was able to reduce the effect of the marital estrangement on the child. At the end of the 10 contracted family sessions, the parents agreed to begin working on their relationship in couples therapy, which led shortly thereafter to a reconciliation.