Intergenerational transmission of violence - The effect of working alliance on treatment outcomes in intensive groupbased treatment for multiproblem families

Introduction: Within the department of Yulius Family Psychiatry multiproblem families are treated. These families have multiple problems, both at the individual level (psychopathology of parents and children, substance abuse)... [ view full abstract ]

Introduction: Within the department of Yulius Family Psychiatry multiproblem families are treated. These families have multiple problems, both at the individual level (psychopathology of parents and children, substance abuse) and in their relationships (domestic violence) and broader context (small social network, financial problems). Previous treatments have failed in these families, which have caused feelings of powerlessness and mistrust towards care professionals. For all clients and forms of treatment a good working alliance is a prerequisite for positive treatment outcomes (McLeod, 2011). Because of their previous negative experiences for these families it is all the more important, but also more difficult, to build a good working alliance. Therefore, we investigate in this study the development of working alliance over the course of treatment, and its association with treatment outcomes.

Method: 114 multiproblem families have been in treatment between April 2015 and December 2016. Working alliance is measured with observations two times during treatment (beginning and end) with the SOFTA (Friedlander et al., 2006) and through self-report (SRS; Miller et al., 2000). Psychopathology of parents is measured with the Outcome Questionnaire (OQ-45; Lambert et al., 1996), and in children with the Strength and Difficulties Questionnaire (SDQ; Goodman, 1997). Family functioning is measured with the Family Assessment Device (FAD; Epstein et al., 1978) and the OBVL (Vermulst et al., 2011).    

Results: Over the course of treatment parents’ (F(1,113)=43.89, p<.001) and children’s (F(1,113)=81.89, p<.001) psychopathology improves, as well as parenting stress (F(1,113)=82.59, p<.001) and family functioning (F(1,113)=66.15, p<.001). Also the working alliance improves. More engagement and a positive emotional connection between client and therapist is associated with improved functioning.      

Conclusion: Multiproblem families are hard to involve in treatment. When however these families can be motivated for treatment positive results can be achieved.