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It’s All About the Balance: Therapists’ Experience of Systemic Alliance Development

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Building a therapeutic alliance with clients is an essential therapeutic task and primary skill taught in all clinical training programs. However, there is less research available that addresses how the therapeutic alliance changes when the client is a couple or family system. This study utilized focus groups with therapists at varying experience levels to explore how they conceptualized and practiced alliances with couple and family clients. All therapists emphasized the systemic therapeutic alliance as vital to progress. Less experienced therapists conceptualized alliance as connecting to each individual separately and equally. More experienced therapists focused on building an alliance with the client system, as well as individual clients. Using modified grounded theoretical analysis, three themes emerged: (a) create the systemic alliance, (b) monitor the system’s complexity, and (c) balance individual and systemic needs. Implications and recommendations for clinicians, educators, and supervisors are presented. A model of systemic alliance in the process of couple and family therapy is introduced and discussed.

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The authors wish to thank Crystal Sistoni for her substantial contribution to the research process.

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Correspondence to Susan N. Perkins.

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Perkins, S.N., Glass, V.Q. & D’Aniello, C. It’s All About the Balance: Therapists’ Experience of Systemic Alliance Development. Contemp Fam Ther 41, 420–434 (2019).

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