Abstract: The problem. The purpose of this study was to examine the alliance between the therapist and individual family members, the within-family alliance or Shared Sense of Purpose, and the therapist's contribution to the alliance in Behavioral Family Management (BFM) and to determine how these alliances related to first use of rescue medications by patients with schizophrenia. Method. The SOFTA-o was used to code the alliance in 29 early therapy sessions of BFM. The relationship between the alliance and the number of days until first use of rescue medication were statistically analyzed. Results. After controlling for psychopharmacological treatment, the data supported hypothesis two that predicted that there would be a statistically significant relationship between the alliance of the family members in BFM and the number of rescue medication was administered to the patient. All Relative Engagement was statistically significant (p ≤ .03) when fitted in a Cox model with Therapist Engagement. The data supported hypothesis three that predicted that there would be a statistically significant relationship between Shared Sense of Purpose within the family in BFM and the number of days until rescue medication was administered to the patient. Shared Sense of Purpose individually predicted a good outcome and was statistically significant (p ≤ .03). The data supported hypothesis four that stated that there would be a significant relationship between the alliance of the therapist with family members in BFM and the number of days until rescue medication was administered to the client with schizophrenia. Therapist Engagement emerged as a unique predictor of outcome. Therapist Engagement individually predicted outcome (p = .007) and independently predicted outcome when fitted in a model with All Relative Engagement and Family Shared Sense of Purpose. The data did not support the first hypothesis. No relationship was found between the client with schizophrenia's alliance with the therapist and days until first use of rescue medication. This was the first study using the SOFTA-o to measure the alliance in BFM. Results suggest that the therapeutic alliance has a strong impact on outcomes in BFM in the treatment of schizophrenia.