Therapeutic Alliance Matters to Children in Multisystemic Therapy

Antisocial youth, particularly those with violent tendencies, have been able to find some relief from their symptoms through multisystemic therapy (MST). This type of approach involves the child and the parents in order to address behavioral issues that are influenced by and affect the entire family. Additionally, parents are taught how to discipline their children, set boundaries, and monitor the activities of their children. This is particularly important when the children reach adolescence, a time in which violence can escalate and antisocial youth are more likely to engage in risky behaviors. One of the most important aspects of MST, and other therapies as well, is thought to be the therapeutic alliance, the relationship between the therapist and the client. In MST however, that relationship is not confined to the therapist-child dyad, but also extends to the therapist-parent bond.

Because the majority of parents who attend MST with their children are mothers, maternal mental health must be considered. Women with maternal depression may be less likely to actively participate in therapy, adopt the tools being taught, and follow-through at home with monitoring and discipline. Therefore, it would seem reasonable to assume that reducing maternal depression could indirectly improve antisocial behavior in children. To test this theory, and more specifically, to determine if a strong therapeutic alliance between therapist and mother decreased maternal depression and indirectly improved behavior in children in MST, Isabele Granic of the Behavioral Science Institute at Radboud University in the Netherlands recently led a study examining this dynamic in 89 children and their mothers undergoing treatment.

The families were monitored before, during, and after MST and ratings of alliance were gathered from the therapists and the mothers. Maternal depression and child behaviors were also assessed. Granic found that strong therapist-mother alliances resulted in clinician reports of reduced maternal depression and improved child behavior. However, when these ratings were obtained from the mothers, the gains were significantly weaker, suggesting that the mothers’ views were less objective and perhaps somewhat distorted by their depressive symptoms. Regardless, Granic believes that these results show that alliance can have a positive effect on maternal depression and antisocial behavior in children. “Our findings suggest that the early establishment of a strong alliance (at least as perceived by the clinician) may be an important step toward successful adolescent outcomes in MST,” Granic said.

Granic, Isabela, Roy Otten, Kristen Blokland, Tracy Solomon, Rutger C.M.E. Engels, and Bruce Ferguson. Maternal depression mediates the link between therapeutic alliance and improvements in adolescent externalizing behavior. Journal of Family Psychology 26.6 (2012): 880-85. Print.

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    January 16th, 2013 at 12:03 AM

    What I do not understand about this study is – the young people involved here, they had a problem with antisocial behavior. Does this not mean they were already disconnected from their parents and they wouldn’t listen to them? So how do they expect such youngsters to go to therapy along with a parent? Seems like a paradox to me. Would love it if someone gave me their own perspective here.

  • Caroline


    January 16th, 2013 at 3:54 AM

    Those who are depressed can’t always be trusted to have the most objective point of view. But for the child in therapy, they will typically be able to tell you if this is working for them or not, and as for any of us, a great working relationship with the therapist is going to be a key element for their overall success.

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