Operationalization of Dimensions

While the FTOARS was designed for couples and family work, the first three dimensions could also apply to individual sessions, inasmuch as the behaviors of individual family members are rated. The fourth dimension, however, Shared Sense of Purpose Within the Family, is designed to rate, at a minimum, two family members seen conjointly. Depending on the investigator’s purpose, the entire family system or subsystems (e.g., sibling, parental) could be rated on this dimension.

The instrument is designed to be pantheoretical, that is, to reflect aspects of the alliance that are not theory-specific. It is our assumption that all four dimensions are crucial for a solid working alliance in couples and family therapy, but some dimensions may be more salient than others depending on the therapeutic approach, the treatment setting, or the stage of therapy. The dimensions that seem most likely to vary by context are Safety and Emotional Connection to the Therapist, but the accuracy of this assumption is an empirical question that remains to be investigated.

The following are the operational definitions of the four dimensions in the FTOARS:

ENGAGEMENT IN THE THERAPEUTIC PROCESS: the client viewing treatment as meaningful; a sense of being involved in therapy and working together with the therapist, that therapeutic goals and tasks in therapy can be discussed and negotiated with the therapist, that taking the process seriously is important, that change is possible

EMOTIONAL CONNECTION TO THE THERAPIST: the client viewing the therapist as an important person in his/her life, almost like a family member; a sense that the relationship is based on affiliation, trust, caring, and concern; that the therapist genuinely cares and “is there” for the client, that he/she is on the same wavelength with the therapist (e.g., similar life perspectives, values), that the therapist’s wisdom and expertise are valuable

SAFETY: the client viewing therapy as a place to take risks, be open, vulnerable, flexible; a sense of comfort and an expectation that new experiences and learning will take place, that good can come from being in therapy, that conflict within the family can be handled without harm, that one need not be defensive

SHARED SENSE OF PURPOSE WITHIN THE FAMILY: family members seeing themselves as working collaboratively in therapy to improve family relations and achieve common family goals; a sense of solidarity in relation to the therapy, “we’re in this together;” that they value their time with each other in therapy; essentially, a felt unity within the family in relation to therapy

It should be noted that, like other multidimensional alliance measures (e.g., Horvath & Greenberg’s [1989] Working Alliance Inventory or Pinsof & Catherall’s [1986] Integrative Psychotherapy Alliance Scales), the four FTOARS dimensions are not mutually exclusive. Indeed, because they are conceptually interdependent, they are likely to be moderately correlated. Thus, a client’s sense of safety is closely related to his or her emotional connection to the therapist and feeling engaged in the process. All of these dimensions are likely to be stronger when the entire family shares a common sense of why they are in therapy and what they hope to accomplish as a result.