Psychotherapy 2011, Vol. 48, No.

2, 138 147

2011 American Psychological Association 0033-3204/11/$12.00 DOI: 10.1037/a0022188

Using the e-SOFTA for Video Training and Research on Alliance-Related Behavior
Valentn Escudero
University of La Coruna

Myrna L. Friedlander
University at Albany, State University of New York

Laurie Heatherington
Williams College
In this article, we describe a specific technology for training/supervision and research on the working alliance in either individual or couple/family therapy. The technology is based on the System for Observing Family Therapy Alliances (SOFTA; Friedlander, Escudero, & Heatherington, 2006), which contains four conceptual dimensions (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family), observational rating tools (SOFTA-o), and self-report measures (SOFTA-s) shown to be important indicators of therapeutic progress. The technology, e-SOFTA, is a computer program (available for PC downloading free of charge) that can be used to rate client(s) and therapist on the specific SOFTA-o behaviors that contribute to or detract from a strong working alliance in each dimension. In addition to providing time-stamped frequencies of alliance-related behaviors, e-SOFTA allows users to link the observed behaviors to qualitative comments and to compare one persons rating of a session to that of another person. Suggestions are provided for using e-SOFTA in research, in didactic training, and in supervision, including a specific training module for introducing graduate students to the working alliance and assessing their observational and executive skills. Keywords: working alliance, training, supervision, technology, psychotherapy process research

Of the many technique- and relationship-related factors that account for change in successful psychotherapy, the working alliance is undoubtedly the most robust. The felt sense of collaboration between therapist and client, including an emotional bond and negotiation of therapy tasks and goals, has consistently predicted favorable outcomes in study after study and in multiple literature reviews and meta-analyses, the most recent of which reported an aggregate r .275 (Horvath, Del Re, Fluckiger, & Symonds, 2011). Although research on the alliance in couple and family therapy (CFT) has been slower to develop, a comprehensive metaanalysis of this literature (Friedlander, Escudero, Heatherington, & Diamond, 2011) yielded strikingly similar results, r .26 (weighted average effect size). In this article we describe a technology that can be used for training/supervision and research on the alliance in both CFT and individual psychotherapy. With sufficient evidence that the working alliance matters across therapy modalities, the next step is to use this information to identify the kinds of client behaviors and therapist techniques

Valentn Escudero, Department of Psychology, University of La Coruna, La Coruna, Spain; Myrna L. Friedlander, Department of Educa tional and Counseling Psychology, University at Albany, State University of New York; Laurie Heatherington, Department of Psychology, Williams College. Correspondence concerning this article should be addressed to Valentn Escudero, Department of Psychology, University of La Coruna, 15071 La Coruna, Spain. E-mail: valentin.escudero@udc.es 138

that reflect and strengthen the alliance (Hatcher & Barends, 2006). That is, we need to know howas therapists, trainees and supervisorswe can infer the strength of the alliance in a stream of interview behavior. By monitoring and responding to client behavior that compromises the alliance in the moment, we are in the best position to repair a rupture before it can have a lasting or detrimental effect on treatment (Muran, Safran, & Eubanks-Carter, 2010). Inferring clients thoughts and feelings about the alliance is particularly challenging in couple and family therapy, where at any given moment there are myriad interpersonal and intrapersonal events taking place. Notably, there is little guidance in the CFT literature about the kinds of in-session behavior demonstrated by engaged and successful clients (Friedlander, Wildman, Heatherington, & Skowron, 1994). When family members have differing motives, motivations, and degrees of readiness for therapy, several interacting alliances need to be monitored simultaneously. In other words, not only are the individual alliances (i.e., each family member with the therapist) important, but the alliances between and among family members must also be considered. Because each client-therapist alliance is observed by all family members, these multiple alliances do not develop in a vacuum, but rather systemically, each one affecting and being affected by the others. For example, the parents alliances with the therapist may be strengthened when they see their adolescent responding favorably to the therapists interventions; conversely, one parent may become annoyed if the therapist seems to be siding with the other parents view of how to handle the children.

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Accordingly, conjoint therapy alliances are frequently split (e.g., Heatherington & Friedlander, 1990; Muniz de la Pena, Fried lander, & Escudero, 2009; Pinsof & Catherall, 1986), when one partner or family member has a notably stronger alliance with the therapist than does another. Split alliances vary in severity and have implications for retention and outcome in complex ways (Escudero, Heatherington & Friedlander, 2010; Friedlander, Escudero, & Heatherington, 2006; Muniz de la Pena et al., 2009; Pinsof, 1994). Thus, simultaneous monitoring of each family members alliance is arguably more difficult in conjoint CFT than it is in individual therapy. In 2006 we introduced a conceptual model of CFT alliances, the System for Observing Family Therapy Alliances (SOFTA; Friedlander, Escudero, & Heatherington, 2006; Friedlander, Escudero, Horvath et al., 2006), with accompanying self-report measures (SOFTA-s) and observational rating systems (SOFTA-o). The latter can be used with software technology (e-SOFTA) to assess the strength of CFT (as well as individual therapy) alliances in videotaped sessions. In the sections that follow, we describe the SOFTA-o and the e-SOFTA and its use in research, graduate training, and supervision, including a description of how it is being taught to graduate students in a Spanish postgraduate program in family therapy. The article concludes with a discussion of the limitations of this software program.

stream of behavior (their own behaviors as well as those of their clients) and then to estimate alliance strength on multiple dimensions based on behaviors observed in the session.

Making Alliance Ratings

Alliance strength is assessed on an ordinal scale: 3 extremely problematic, 2 moderately problematic, 1 somewhat problematic, 0 unremarkable or neutral, 1 somewhat strong, 2 moderately strong, and 3 extremely strong. This global rating is made after observing and tallying the frequency of specific verbal and nonverbal behaviors clustered within each of the four dimensions. In the client SOFTA-o, most of the lowinference indicators reflect behaviors, negative as well as positive, that occur in all forms of therapy (e.g., client avoids eye contact with the therapist, client implies or states that therapy is a safe place, family members offer to compromise), as well as behaviors that reflect specific theoretical approaches, for example, cognitive behavioral (e.g., client agrees to do homework) and structural-strategic family therapy (e.g., client complies with therapists request for an enactment). In the therapist version, the behavioral contributions are largely theoretically nonspecific, for example, therapist expresses optimism or notes that a positive change has taken place or can take place; therapist provides structure and guidelines for safety and confidentiality, therapist argues with the client(s) about the nature, purpose, or value of therapy. Whereas Shared Sense of Purpose is assessed for the couple or family unit as a whole, Engagement, Emotional Connection, and Safety are assessed separately for each individual client. The Safety dimension includes indicators that relate to individual behavior (client shows vulnerability, e.g., discusses painful feelings, cries) as well as family transactions (client reveals a secret or something that other family members didnt know); when the Safety aspect of the alliance is used to assess client comfort in individual psychotherapy, the user simply ignores the transactional indicators in this dimension. In total, there are 44 client and 43 therapist behaviors across the four dimensions (10 or 11 per dimension). Some therapist behaviors parallel client behaviors, for example, therapist asks client(s) about the impact or value of a prior homework assignment and client indicates having done homework or seeing it as useful. In developing the SOFTA-o, we did not assume that these behaviors reflect the universe of alliance-related behavior. Rather, the SOFTA-o items direct the users attention to common markers of alliance strength or weakness (Friedlander et al., 2006). To rate the alliance from a videotape, the user keeps a written tally of each SOFTA-o behavior as it is observed to occur (either on a paperand-pencil checklist or using the e-SOFTA computer program), rewinding the tape as needed. When in doubt, the user may refer to the training manual for operational definitions of each item. For example, for the item Family members offer to compromise, the manual provides the following operational definition:
The offer may or may not be in response to the therapists request for a compromise. Sometimes the clients offer to another is clear, as in Well, if I do [this], will you do [that]? A client might only make one part of the offer, such as I could [do this] or Im willing to . . . . Typically people compromise on something behavioral, but the compromise could also be cognitive, such as Ill try to stop looking for

Description of the SOFTA-o Overview of the Instrument

The SOFTA-o (Friedlander et al., 2006a, 2006b) was developed inductively and simultaneously in English and Spanish (the Sistema de Observacion de la Alianza Terapeutica en Intervencion Familiar, or SOATIF; Escudero & Friedlander, 2003) as an observational tool for assessing the strength of therapeutic alliances in CFT. Briefly, the SOFTA model consists of four interrelated, transtheoretical dimensions of the alliance: Engagement in the Therapeutic Process, which reflects Bordins (1979) agreement with the therapist on tasks and goals; Emotional Connection with the Therapist, which is similar to Bordins concept of clienttherapist bond; Safety within the Therapeutic System, which reflects each clients degree of comfort taking risks, being vulnerable, and exploring conflicts with a therapist and other family members; and Shared Sense of Purpose within the Family, which refers to productive family collaboration (the within-family alliance). The SOFTA-o contains both client and therapist versions. Whereas the clients alliance-related behaviors reflect their thoughts and feelings about the strength of the alliance (e.g., client expresses interest in the therapists personal life Emotional Connection), therapists behaviors refer to positive and negative contributions to the alliance, that is, interventions that either strengthen (e.g., therapist discloses some fact about his or her personal life) or detract from (e.g., therapist fails to address one clients stated concerns by only discussing another clients concerns) the working alliance (Friedlander et al., 2006). In other words, the SOFTA-o reflects the clinical inference process. Just as therapists make inferences about the strength of the alliance by observing clients in-session behaviors, the SOFTA-o is a systematic method for training therapists what to pay attention to in the

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ESCUDERO, FRIEDLANDER, AND HEATHERINGTON the negative in everything, if you do. The therapist might ask each member of the family to think of something positive to do in relation to other family members, and if the client comes up with something, that could be considered a compromise, such as, Ill help Mom with the dishes. These statements need to be considered in a context of quid pro quo. That is, if a client merely offers to do something different without an implicit or explicit expectation that another family member will also do something in return, the item Client offers a plan for improving the situation (Engagement) should be considered instead.

more valuable than their other sessions were characterized by significantly higher Engagement ratings (Friedlander et al., 2010), and (b) clients whose behavior indicated greater Engagement tended to report a stronger perceived alliance with the therapist (Escudero et al., 2008). In other studies, clients with low Safety ratings in early sessions tended to do poorly in treatment (e.g., Beck et al., 2006; Friedlander, Lambert, Escudero, & Cragun, 2008), and strong Shared Purpose ratings in Session 1 predicted parents ratings of improvement-so-far in Session 3 (Friedlander et al., 2008).

The training manual should also be consulted any time the person analyzing the session is at all uncertain about of the meaning of the four alliance dimensions. For example, Emotional Connection to the Therapist is defined as:
The client viewing the therapist as an important person in her/his 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 or she is on the same wavelength with the therapist (e.g., similar life perspectives, values), that the therapists wisdom and expertise are valuable. (Friedlander et al., 2006, p. 270)

Using the e-SOFTA Description of the Software

The e-SOFTA software application program was developed to provide a fine-grained analysis of easily observed client and therapist behaviors related to the therapeutic alliance. One unique aspect of the e-SOFTA is its facilitation of training by allowing for a direct comparison of two users work. Thus, trainee and supervisor (or two researchers) can independently observe a session, record their observations of client and therapist behavior as well as their clinical impressions and then compare their results, that is, to see whether they both noticed the same alliance indicators, interpreted them in the same way, and rated the alliance strength similarly.

After the session has been observed in entirety,1 the user considers the definitions of each dimension and evaluates the tallied positive and negative behaviors in order to assign the client or therapist with a global alliance rating (from 3 to 3) for each dimension. A set of rating guidelines direct the user to consider the valence (positive or negative), frequency, intensity, and clinical meaningfulness of the observed behaviors. For example, when no alliance-related behaviors are observed in the session, a global rating of 0 (unremarkable or neutral) must be assigned. Ratings between 1 and 3 are assigned when only positive behaviors are observed; ratings must be between 1 and 3 when only negative behaviors are observed. The rating must be 1, 0, or 1 when both positive and negative behaviors are observed in the session. Thus, each individual client receives a global rating for Engagement, Emotional Connection and Safety2 (In the case of couple of family therapy, a global rating for Shared Sense of Purpose within the Family is made for the entire unit.). The therapist receives a global rating on each dimension, reflecting the degree to which his or her interventions contributed to or detracted from the strength of the alliance.

Getting Started
The e-SOFTA can be downloaded free of charge at www.softa-soatif.net. This website offers information and materials related to the SOFTA (references about relevant studies with the measure, definitions of essential concepts related to the alliance, resources, etc.). In order to install the e-SOFTA (at this time, only available for Microsoft Windows) from the website, the user should click on SOFTA Instruments and then on Download the e-SOFTA and videos for training, free of charge. The SOFTA Instruments section contains a Tutorial for the e-SOFTA as well as the SOFTA-s, our self-report alliance questionnaire, with parallel versions for clients and therapists (in English, Spanish, French, Italian, Swedish, and Hebrew). We recommend that potential users click on Tutorial for the e-SOFTA before installation in order to become familiar with all functions of the program. Then, after Download the e-SOFTA is clicked, a brief questionnaire appears; completion of this question1 Depending on the users purpose, the behavioral indicators may be of more interest than the global alliance ratings. In research, we typically rate the entire session, but the measure can also be used to observe behaviors and rate clients or the therapist globally on only a portion of a session. 2 The Safety within the Therapeutic System contains four client items and four therapist items that pertain either to individual or conjoint treatment; the other Safety items are only relevant when multiple clients are in the session (e.g., therapist helps clients to talk truthfully not defensively with one another). Thus Safety ratings can be made for individual therapy by only considering the items that pertain to one client (e.g., client shows vulnerability or therapist acknowledges that therapy involves taking risks or discussing private matters).

Research Support for the SOFTA-o

In research used to develop the SOFTA-o, interrater reliabilities (ICCs) ranged from .72 to .95 across the four dimensions (Friedlander et al., 2006a). Construct validity (factorial, knowngroups, concurrent, predictive) for the measure has been demonstrated with various samples of couples and families (e.g., Beck, Friedlander, & Escudero, 2006; Escudero, Friedlander, Varela, & Abascal, 2008; Friedlander, Bernardi, & Lee, 2010; Friedlander et al., 2006, 2008; Friedlander, Escudero et al., 2006; Muniz de la Pena et al., 2009; Smerud & Rosenfarb, 2008) in the U.S., Canada, and Spain. Although a review of research with the SOFTA-o is beyond the scope of this article, findings related to the Engagement dimension, for example, indicate that (a) sessions perceived by clients to be relatively

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PROCESS

ACTIONS

HELP

Try the example 1. In the File menu, click on 1. If the video cannot be seen, it is likely that installation of additional applications is required (JRE and JMS, which are available on the website)

Get started

Download from the website 1. At www.softa-soatif.net click on Softa Instruments and then on Download the eSOFTA 2. Complete the questionnaire 3. Download the program and the training videos 1. Read first the general information about the instrument, clicking on SOFTA 2. All fields must be filled in 3. Carefully follow the Download instructions in website. Check to see if your computer already has the applications needed for the program (i.e., JRE and JMS) Initial Practice

Training and then select the Example.sfc project; using the video control functions, play the example.

Tutorial 1. First, read the Tutorial, clicking on Help in the menu bar of the program 1. Follow the Tutorial step by step

Open a training example 1. Clicking on File and then Install the program 1. Decompress the downloaded files with WINZIP. 2. One of the decompressed files is named SOFTASETUP;double-click on it to start the installation process; at the end the SOFTA-o icon will appear on the computer desktop 1. The program can only be installed in Microsoft Windows 2. During the installation process, a choice of installation options will appear Rating 1. Play the video and make the ratings, behavioral and then global. 1. The Help function on the menu bar includes descriptions of the behavioral indicators to guide the
rating process

1. Remember to decompress the files downloaded from the website and put them in the adequate folder as indicated in the Download instructions on the website

on Open will bring up a list of training examples that you previously downloaded; select one to view.

Figure 1.

The process of using the e-SOFTA.

naire allows us to track usage of the tool for training and research. After this questionnaire is submitted, the user will be taken to the download function, where there are specific instructions for downloading the software as well as a set of training videos. Figure 1 summarizes the steps that a potential user should follow to get started. The e-SOFTA is currently available in English and Spanish (Portuguese, Hebrew, and Italian versions of the SOFTA-o are also available on the website, but only in the paper-and-pencil format). The software package contains the rating screen (described below), the training manual for the SOFTA-o (with all operational definitions), and several brief training vignettes in English and Spanish. These vignettes are role-played sessions that illustrate various indicators of positive and negative client behaviors in the Engagement, Emotional Connection, Safety, and Shared Sense of Purpose alliance dimensions. After training with the vignettes, users can refer to the Project Wizards user manual (described below) to load their own videos into the software program and to set up video projects to rate the client and/or therapist behaviors.

Working With the e-SOFTA

Figure 2 depicts the software screen with a sample video; the project has been set to the client Safety dimension. At the top of the Figure on the toolbar, we see the File menu, which functions to open an existing rating project or create a new one. Next to File is the word Language, which asks the user to choose English or Spanish. Finally, Help on the toolbar allows the user to consult the training manual for the SOFTA-o alliance rating system (with a description of the measure, its reliability, operational definitions for items and dimensions, and rating guidelines) or a tutorial for using the e-SOFTA program. In the screen in Figure 2, we see a female therapist and two clients, a heterosexual couple. Under the video screen is the time bar, with stop and start buttons. To the right of the video are four tabs, one for each of the SOFTA-o alliance dimensions. Because this project was configured to rate the clients (rather than the therapists) behavior, the columns to the right of the video are labeled Husband and Wife. (If the therapist behavior were to

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Saving the project work 1. When the ratings are completed (or a break is needed), go to File and then to Save

ESCUDERO, FRIEDLANDER, AND HEATHERINGTON

2. Indicate the SOFTA 1. Review the options for saving the project dimensions to be used in the analysis (the Default option includes all four dimensions)

Name the project Creating a project Define who is to be rated 1. Clicking on File, then New, then Family will bring up a window to define the clients in the therapy session 2. Alternately, click on Therapist (if the therapist behaviors are to be rated) Rating and Saving 1. The same procedure is used as described above (for Practicing). 1. Refer to the Tutorial and be sure to store the video in the same folder as the project after the project has been saved. Select the video and dimensions 1. In the window for a New project, indicate (with the help of the browser) the video to be rated. 1. The video recording must be located in the computers hard drive and must be recorded in a common digital format (i.e., mpg or .mov) 1. A name or label must be given for any client in the session whose behavior is to be analyzed. 1. After the clients, video, and dimensions are selected, the program will ask for the name of the project. 1. Whenever the named project is opened, the video and your ratings will be viewed, but the video and sft files must be stored in the same folder in the computer.

Figure 1. (continued)

be rated, the user would have configured the project so that the column is headed Therapist.) In the Figure, the Safety tab is lit, and the list of Safety behaviors are abbreviated. (When the user moves the cursor over a given item, the complete behavioral item appears.) Although this Figure is in black and white, the actual e-SOFTA screen is in color. Blue items denote positive Safety behaviors; red items denote negative behaviors. The numbers in the cells to the right of the items indicate the tallies, that is, how many times Husband and Wife displayed each Safety behavior. In this example, the husband varied his emotional tone once, encouraged his wife to open up once, and twice asked her for feedback about his behavior. For her part, the wife expressed anxiety nonverbally twice, protected herself in a nonverbal manner once, and was reluctant to respond once. (A cell with zero indicates that the behavior listed to the left was not observed in the session.) At the bottom of the two columns are the global alliance ratings. The husband received a Safety rating of 3 (extremely strong), whereas the wifes rating was 3 (extremely problematic). One unique and useful aspect of the e-SOFTA is the opportunity for tagging qualitative comments to the tallied alliance ratings. In this Figure, when the user clicked reluctant to respond for the

wife, the Comments box opened up, and the user wrote, She doesnt answer her husbands question about the time they spend with the children. Note that the time at which this behavior occurred, 00:01:03 (roughly one minute into the session), is stamped to the left of the users comment. In the comparison comment, listed underneath, a second user wrote, She clearly doesnt want to answer her husbands question about the amount of time theyve both spent with the children in the past week. This comparison comment is shown because two users had (independently) rated the video.

Configuring a Project
Readers who wish to examine e-SOFTA using one of the training videos from the SOFTA website (www.softa-soatif.net) should first download this video into their computers. Try, for example, cl_connect_A.sfc, a brief vignette showing a family that has already been rated on the Emotional Connection dimension. In the File menu, click Open and select cl_connect.A.sfc from within your computer files. (The extension .sfc indicates that this video project has already been rated and has been saved for comparison, i.e., .sfc.) The e-SOFTA screen will open at this point.

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Figure 2.

Sample e-SOFTA Rating Screen.

Before using e-SOFTA with a personal video, that video needs to be uploaded into the users computer. Then, a rating project can be configured using the Project Wizard. To do so, the user clicks the File menu on the tool bar; under New, the tab Family Members/Clients is activated. (If the user wants to rate the therapist, Therapist should be chosen. If there are one or more clients, Family should be chosen.) Then the user must use the add button to identify each individual to be rated by role (e.g., mother, father, son) or by name (Alice, John). When there are multiple clients, each person needs to be identified; this is accomplished simply by typing in either the role or name and then clicking add. (This last option is not necessary if Therapist is chosen.) Next, by clicking the Video tab, the video to be rated is located. The Browse button allows the user to search the available files in the computer to locate the video of interest. After a specific video has been selected, the user must name this new video, for example, Jennifer_Smith.sft or Harrison_Family_ July_10_2010.sft (note that the program will automatically add the .sft extension when the user names the project). This process allows a users video to be loaded into e-SOFTA. Next, the user clicks on the Dimensions tab to choose a single alliance dimension (e.g., Engagement) or multiple dimensions for rating. Finally, by clicking Accept, the project automatically appears on the rating screen with the selected video. It should be noted that if the user wishes to rate both the clients and the therapists behavior, the project needs to be configured twice, since the alliance behaviors for client and therapist differ.

Making Alliance Ratings in e-SOFTA

After a new project has been configured (i.e., with an .sft extension), the video screen (i.e., Figure 2) appears with the video selected by the user. Clicking the start triangle on the time bar will begin the video stream, with the time stamps shown below the screen. Whenever the user observes a SOFTA-o alliance behavior listed on the right, he or she clicks the cell to the right of the item. If the user is not certain about whether an item should be tallied (e.g., whether the clients behavior is consistent with the definition of reluctant to respond), a click on Help and then Descriptors will bring up a small window with the items entire operational definition. At any point, the user can pause the video and record qualitative impressions of specific alliance behaviors, the entire session, or whatever is of interest. After the video has been rated in entirety, the user assigns a global rating to each client (from 3 to 3). (The Help tab provides the operational definitions of all items and dimensions, as well as the specific rating guidelines). If the user makes an error on the rating scale a message will pop up automatically when the user tries to save the project. For example, in Figure 2, since the Husband only had positive tallies, the rating needed to be 1, 2, or 3. If the user had clicked 0, a window with the following message would have appeared when the user tried to Save the project: If only positive items are checked, the score must be above 0. The global alliance ratings are automatically configured in the form of graphs by e-SOFTA (see Figure 3). To arrive at this

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Figure 3.

Sample Solution Page in e-SOFTA.

screen, the user simply clicks Results in the main screen (to the right of the four alliance dimension tabs). A file is also created automatically with all of the behavioral indicators and qualitative comments, chronologically ordered. To access this file, the user clicks on the parchment icon in the left-hand corner above the video. The vignettes provided with the e-SOFTA (on the website, with the program) are structured for a single alliance dimension, for example, Engagement. In actual practice, however, users will want to rate all four dimensions. This is accomplished simply by moving between the alliance tabs listed horizontally at the top of the behavioral items. For example, if the client initiates a new problem for discussion (a positive Engagement item) and, in the next speaking turn, asks the therapist a personal question (a positive Emotional Connection item), the user would first click new problem for discussion under the Engagement tab, then click on the Emotional Connection tab to open that series of items and click shows interest in the therapists personal life). In other words, to rate all four alliance dimensions, the user simply moves back and forth using the tabs above the behavioral items.

Using e-SOFTA in Psychotherapy Process Research

The e-SOFTA has been used in diverse psychotherapy studies, from case studies (Friedlander, Lambert, Escudero, & Cragun, 2008) to group comparison designs (Escudero et al., 2008). Although the data generated by the paper and pencil version of the SOFTA should not differ from the data generated by the e-SOFTA, the advantages and possibilities of using the computer program are immense, not only to economize coding time, but also to maximize the precision and quality of the resulting alliance information. Interrater reliability is extremely important when therapy sessions are analyzed for research purposes, and e-SOFTAs comparison function (described above) significantly facilitates the process of converging multiple raters to achieve high levels of reliability. Using projects that have been saved for comparison (i.e., the creation of sfc files) allows different judges to analyze the same videos independently and then contrast differences in their ratings by easily reviewing the exact moments where each rater recorded the presence of a specific behavioral indicator. The addition of text comments time stamped to the tallied behavioral indicators allows different judges to consider the perceptions and interpretations made by other independent raters. Compared with using the paper-and-pencil version of the SOFTA-o, a major advantage of using the software for research is that it allows users to combine the quantitative results (frequencies of behavioral indicators) with a qualitative analysis (the text recorded in the comments box). The potential linking of the qualitative analysis to the specific observed behaviors, as well as recording the precise timing of occurrences in the session, allows for a process analysis that can only be accomplished with much investment of time and energy using paper and pencil ratings (i.e., manually coordinating written comments with the time counter on a VCR or computer). Moreover, the e-SOFTA allows users to save their results in a format that can easily be exported to data files for sequential analyses. One example is the transformation of data into SDIS files (Sequential Data Interchange Standard; Bakeman & Quera, 1996).

Saving a Project for Research, Supervision, or Self-Supervision

A users ratings can be saved for subsequent review or for comparison with another users ratings (e.g., a supervisor, peer, or another researcher). Projects can be saved either in normal mode or in solution mode (i.e., Save for comparison). When a user wants to return to a project at a later point, the normal mode is used by saving the file with the .sft extension. Solution projects, on the other hand, are saved with the .sfc extension; these are employed when the purpose is to compare one users results to those of another user. In other words, the File menu offers three ways to save the project: Save (which includes the most recent changes; .sft), Save As (which allows a copy of the project to be saved under a new file name with the .sft extension), or Save for comparison (which saves the project for future comparisons; .sfc).

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Using e-SOFTA in Didactic Psychotherapy Courses

Given the consensus of theorists and researchers that particular attention should be paid to the working alliance in all approaches to psychotherapy, the SOFTA model can be introduced early on in graduate training. In prepracticum, in traditional didactic courses or seminars, instructors can use the e-SOFTA computer program to demonstrate, with role played and with actual clinical material, how the alliance develops and can be ruptured and repaired. First, the four alliance dimensions can be introduced and described, followed by presentation of the SOFTA-o client behaviors. We recommend beginning with a focus on client behaviors because students must first learn to recognize how clients typically behave when they have positive versus negative thoughts and feelings about their collaboration in therapy. Discussion can follow on the overlap between the four SOFTA dimensions and on the uniqueness of the alliance in CFT (i.e., Safety with other family members and the within-family alliance or Shared Sense of Purpose). Readings can be assigned from our alliance book (Friedlander et al., 2006), which contains chapters on the SOFTA model, on the SOFTA-o in general, and on each alliance dimension in particular. Using e-SOFTA in a technology-equipped classroom, the instructor can demonstrate the rating system, dimension by dimension, using the short training vignettes that are available on our website. Students can compare their observations on the four dimensions, on the global ratings, and on the qualitative impressions using the results tab, which shows the correct behavioral and global alliance ratings. Once students are familiar with the SOFTA-o, the instructor can show educational videotapes of therapists (e.g., from APAs Master series) and ask students to demonstrate, individually or collectively, their observational skills. Once students are familiar and comfortable with the client version of the SOFTA-o, the therapist version can be introduced. Before seeing the actual therapist behaviors, however, students can be asked to brainstorm the kinds of interventions that they believe can either contribute to or detract from Engagement, Emotional Connection, Safety, and Shared Purpose. Then, after viewing the e-SOFTA training videos, students can again observe one or more master tapes and discuss the interventions they observe related to the alliance. Showing both individual and couple/family therapy videos can help students understand the complexities of alliance development and maintenance in conjoint therapy. Comparing therapist behaviors in videos depicting different theoretical approaches can also be useful for demonstrating how the working alliance is a common relational factor in psychotherapy.

Research Evidence
The first use of the e-SOFTA in family therapy training was evaluated in a pilot study assessing family therapy trainees conceptual and observation skills relating to the alliance (Carpenter, Escudero, & Rivett, 2008). Using the SOFTA conceptual model to understand the alliance in family therapy interventions and the e-SOFTA as an instrument for the students to analyze selected segments of a therapy session, Carpenter et al. assessed the students (a) knowledge and (b) observation skills (SOFTA-o) preand posttraining and compared the accuracy of their observation skills with those of experienced clinicians. With both groups (the family therapy trainees who received the specific SOFTA training and the experienced therapists who received no alliance training), the assessments of knowledge and observational accuracy took place during the first month of the students didactic course and again six months later. Students mean accuracy scores on the knowledge measure improved significantly from 43% to 74% (p .001) and approached significance on the observational test with the e-SOFTA from 43% to 65%, p .08. Notably, the clinicians accuracy scores did not improve significantly over the same period; although their knowledge of the alliance was higher initially, the students scores were roughly comparable to those of the experienced clinicians after six months of training (Carpenter et al., 2008). Carpenter et al.s (2008) pilot study supported the use of the SOFTA conceptual model, the SOFTA-o, and the e-SOFTA in graduate training, inasmuch as results indicated that training in observational skills related to therapeutic alliance can have a positive and measurable effect. Naturally, the next step in this line of research is to assess the use of students skills with confederate and then with actual clients pre- and posttraining. If successful, this pilot project suggests a stepwise method for introducing and assessing the relationship between training in the alliance and outcomes for families in training settings.

Description of a Training Module Using e-SOFTA

Training in the e-SOFTA has continued over the past three years with graduate students in the family therapy training program at the University of La Coruna (Spain) Unit for Family Intervention. That is, the e-SOFTA is a regular and integral part of the training of family therapy graduate students; the therapeutic alliance is introduced as a crucial nonspecific factor in psychotherapy, and enhancing the alliance is explained as a necessary target of the training in CFT practice. Specifically, the alliance module has as its goal to facilitate students attainment of alliance skills in a specific sequence of training in conceptual knowledge, observational skills (i.e., to detect clients alliance-related behaviors using the e-SOFTA technology), and executive skills (to create strong alliances when conducting conjoint family sessions). Practicing with e-SOFTA is an important element in the training, by allowing trainees to review their own sessions as well as to contrast their SOFTA-o alliance ratings and qualitative analyses of the session with their supervisors ratings and analysis. The specific elements of alliance training are the following: (1) A short presentation of the primary studies on the alliance in psychotherapy is followed by an analysis of the unique character-

Using the e-SOFTA in Training and Supervision

Although the e-SOFTA software program has often been used in observational research studies on the alliance, the computer program is also useful for clinical training, supervision, and selfsupervision. In comparison with self-report methods to evaluate the therapeutic alliances, the observational technology allows users to analyze specific alliance-related behaviors as they occur in the stream of the session, both client and therapist behaviors, and to track anecdotal observations that are time-stamped with the video.

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istics and the major concepts in its application to CFT in particular. This review of the literature on the alliance is accompanied by a description of the SOFTA instruments (observational as well as self-report) to assess the working alliance in individual as well as in couple and family therapy. (2) A workshop is presented, specifically focused on the SOFTA, with the objective of providing more in-depth knowledge of the four dimensions of the model and pragmatic knowledge about the SOFTA instruments (observational and self-report). A sample of brief simulated therapy videos illustrating positive and negative behavioral indicators of the alliance is introduced using the e-SOFTA. Students practice rating client and therapist behaviors during the workshop and then are asked to download the e-SOFTA program into their own computers for continued practice at home. (3) In order for students to implement their observational skills using the e-SOFTA, students are asked to analyze a sample of edited segments of family therapy sessions that were previously analyzed by the instructor using the save for comparison function of the e-SOFTA. The analysis of clients alliance-related behaviors is the primary main focus of this part of the training. (4) To enhance the students executive skills, two tasks are undertaken: (a) analysis of therapists positive/negative contributions to the alliance, and (b) self-supervision. The first task consists of asking students to use the e-SOFTA to rate the therapist contributions to the alliance (i.e., using the therapist version of the SOFTA-o) in a selection of edited segments of therapy. These segments were previously rated by the instructor, using the save for comparison function. The qualitative comments inserted throughout the video by the supervisor (below the screen) serve as a guide for understanding the clinical context and meaningfulness of the SOFTA-o item and global ratings. The second task requires the trainees to analyze a few of their own therapy sessions, selected by the supervisor. The trainees are asked to rate tapes of their prerecorded sessions (conducted in the training clinic) and provide qualitative comments using the e-SOFTA. After completing this task, the trainees explain and discuss their self-analysis with the supervisor. This combination of specific observational indicators and dimensional ratings paired with qualitative, clinical comments offers a structured yet flexible framework for supervision.

When impasses are presented (in individual or group supervision sessions), the supervisor can focus on helping the trainee recognize his or her own contribution to the alliance impasse, rewinding the video as needed to detect subtle cues from the client(s) that the trainee may have missed prior to the impasse. The subsequent discussion could focus on the supervisees emotional reactions to the clients behavior before proceeding to a discussion of how to rebuild the alliance. A final strength of the e-SOFTA is its flexibility. Supervisees can rate their own sessions and then compare their ratings (and anecdotal comments) with those of their supervisor in the same file. Supervisors who want to have a quick look at various sessions conducted by their supervisees can use e-SOFTA, ask their trainees to review specific time-stamped excerpts before coming to supervision, and then focus their time together on the most complex or problematic alliance issues.

Limitations of the e-SOFTA

The e-SOFTA requires a separate analysis of clients alliancerelated behaviors and therapists alliance-fostering behaviors. Although studying these two vantage points separately works well didactically during the initial training, and is actually preferable, the separateness of the two series of analyses is a limitation of the e-SOFTA. That is, the technology does not make it possible to combine the analysis of therapist and client behavioral indicators in the same project. In order to do so, the user must open two different projects and move back and forth from one to the other. This limitation, however, can be minimized in training by analyzing the alliance dimensions separately for therapist and clients and discussing them in an integrated way during supervision. In short, the SOFTA-o provides a systemic conceptualization and operationalization of the therapeutic alliance, to be used either for individual or conjoint couple and family therapy. By design, it is a bilingual and multipurpose instrument that serves trainees, supervisees, clinicians as well as researchers. The accompanying e-SOFTA allows users in all settings to make use of the latest technology to study, in real time, how alliances develop and change over the course of a session or an entire treatment. It can be used formally or informally, and we sincerely hope that it will be used to facilitate the training and supervision of individual and couple/family therapists.

Use of e-SOFTA in Ongoing Supervision

Although the e-SOFTA is a highly specific method for practicing observational skills and for supervising trainees executive skills related to the alliance, the technology can be used flexibly in supervision. In our experience, it has been useful to encourage supervisees to identify impasses or ruptures in their engagement with families, detected by e- SOFTA, that is, the negative behavioral items, and bring these to supervision. Both individual and group supervision sessions can be held using the e-SOFTA results as a focal point. By clicking on a cell entry, the supervisee can quickly play back the portion of the session where the alliance indicator was observed and also be reminded of his or her thinking about this point in the session by reviewing what was written in the Comments box.

References
Bakeman, R., & Quera, V. (1996). Analyzing interaction: Sequential analysis with SDIS and GSEQ. New York: Cambridge University Press. Beck, M., Friedlander, M. L., & Escudero, V. (2006). Three perspectives on clients experiences of the therapeutic alliance: A discovery-oriented investigation. Journal of Marital and Family Therapy, 32, 355368. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, 16, 252260. Carpenter, J., Escudero, V., & Rivett, M. (2008). Training family therapy students in conceptual and observation skills relating to the therapeutic alliance: An evaluation. Journal of Family Therapy, 30, 409 422. Escudero, V., & Friedlander, M. L. (2003). El sistema de observacion de la alianza terapeutica en intervencion familiar (SOATIF): Desarrollo trans-cultural, fiabilidad, y aplicaciones del instrumento. Mosaico (Journal of the Spanish Federation of Family Therapy Associations, 25, 3236. Reprinted in Perspectivas Systemicas, 2003, 15.

SPECIAL SECTION: VIDEO TRAINING FOR THE ALLIANCE Escudero, V., Friedlander, M. L., Varela, N., & Abascal, A. (2008). Observing the therapeutic alliance in family therapy: Associations with participants perceptions and therapeutic outcomes. Journal of Family Therapy, 30, 194 204. Escudero, V., Heatherington, L., & Friedlander, M. L. (2010). Therapeutic alliances and alliance building in family therapy. In J. C. Muran & J. P. Barber (Eds.), The therapeutic alliance: An evidence-based guide to practice. (pp. 240 262). New York: Guilford Press. Friedlander, M. L., Bernardi, S., & Lee, H. (2010). Better versus worse family therapy sessions as reflected in clients alliance-related behavior. Journal of Counseling Psychology, 57, 198 204. Friedlander, M. L., Escudero, V., & Heatherington, L. (2006). Therapeutic alliances with couples and families: An empirically-informed guide to practice. Washington, DC: American Psychological Association. Friedlander, M. L., Escudero, V., Heatherington, L., & Diamond, G. (2011). Alliance in couple and family therapy. Psychotherapy, 48, 2533. Friedlander, M. L., Escudero, V., Horvath, A. S., Heatherington, L., Cabero, A., & Martens, M. P. (2006). System for Observing Family Therapy Alliances: A tool for research and practice. Journal of Counseling Psychology, 53, 214 225. Friedlander, M. L., Lambert, J. E., Escudero, V., & Cragun, C. (2008). How do therapists enhance family alliances? Sequential analices of therapist-client behavior in two contrasting cases. Psychotherapy: Theory, Research, Practice, Training, 45, 75 87. Friedlander, M. L., Lambert, J. E., & Muniz de la Pena, C. (2008). A step toward disentangling the alliance/improvement cycle in family therapy. Journal of Counseling Psychology, 55, 118 124. Friedlander, M. L., Wildman, J., & Heatherington, L. (1994). What we do and dont know about the process of family therapy. Journal of Family Psychology, 8, 390 416. Friedlander, M. L., Wildman, J., Heatherington, L., & Skowron, E. A.

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(1994). What we do and dont know about the process of family therapy. Journal of Family Psychology, 8, 390 416. Hatcher, R. L., & Barends, A. W. (2006). How a return to theory could help alliance research. Psychotherapy: Theory, Research, Practice, & Training, 43, 292299. Heatherington, L., & Friedlander, M. L. (1990). Couple and family therapy alliance scales: Empirical considerations. Journal of Marital and Family Therapy, 16, 299 306. Horvath, A. O., Del Re, C., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9 16. Muniz de la Pena, C., Friedlander, M. L., & Escudero, V. (2009). Fre quency, severity, and evolution of split family alliances: How observable are they? Psychotherapy Research, 19, 133142. Muran, J. C., Safran, J. D., & Eubanks-Carter, C. (2010). Developing therapist abilities to negotiate alliance ruptures. In J. C. Muran & J. P. Barber (Eds.), The therapeutic alliance: An evidence-based guide to practice (pp. 304 319). New York: Guilford Press. Pinsof, W. B. (1994). An integrative systems perspective on the therapeutic alliance: Theoretical, clinical, and research implications. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp. 173195). New York: Wiley. Pinsof, W. M., & Catherall, D. R. (1986). The integrative psychotherapy alliance: Family, couple, and individual therapy scales. Journal of Marital and Family Therapy, 12, 137151. Smerud, P. E., & Rosenfarb, I. S. (2008). The therapeutic alliance and family psychoeducation in the treatment of schizophrenia: An exploratory prospective change process study. Journal of Consulting and Clinical Psychology, 76, 505510.

Received August 20, 2010 Revision received October 28, 2010 Accepted November 2, 2010

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