Therapy Process Studies

Change Processes in Family Therapy with Drug Using Youth

J. Alexander,C. Turner, & M. Robbins

This study, funded within our NIDA P50 Center grant, investigates basic social processes in family therapy with the aim of uncovering universal (core) therapist and family behaviors that predict drop out and retention in family therapy with drug abusing adolescents. These universal processes will be established using data from three different family therapy models, working at three different sites, with three ethnically diverse populations. The study is intended to provide the foundation for immediate translation of findings into improvements in family therapy practice. Specifically, this study investigates the role of two universal therapist interventions (Support and Cognitive Restructuring) in effecting the trajectories of two universal family processes (Alliance and Conflict/Negativity, respectively); and the relationship of these universal therapist and family behaviors to dropout and retention.

Alliance Building Interventions with Adolescents in MDFT

G. M. Diamond

In this study, we examined the impact of adolescent engagement interventions on improving initially poor therapist-adolescent alliances (G. M. Diamond, Liddle, Hogue, & Dakof, in press).  The sample was juvenile justice involved, substance abusing inner city teens, most of whom has a dual diagnosis substance abuse and a mental health disorder. Cases with weak therapist-adolescent alliances in the first treatment session were observed over the course of the first three sessions.  Significant gains in working alliance were evident when therapists emphasized the following alliance-building interventions: attending to the adolescent? experience, formulating personally meaningful goals, and presenting as the adolescent? ally.  Lack of improvement or deterioration in alliance was associated with the therapist continually socializing the adolescent to the nature of therapy.  Moreover, in improved alliance cases therapists increased their use of alliance-building interventions from session two to session three (therapist perseverance), whereas therapists in unimproved cases decreased their use (therapist resignation).  These results indicate that overfocusing, or getting stuck, on orienting adolescents to therapy, without moving toward development of a personally meaningful treatment agenda, inhibits formation of a productive working relationship.

Culturally Specific Interventions for African-American Adolescents in MDFT

A. Jackson-Gilfort 

Jackson-Gilfort, Liddle, Dakof, & Tejeda (2001) investigated whether therapeutic discussion of culturally relevant themes enhanced treatment engagement of African American male youths with an inner city Philadelphia sample.  Exploration of anger and rage, alienation, and the journey from boyhood to manhood (i.e., what it means to become an African American man) were associated with both increased participation and decreased negativity by adolescents in the very next treatment session.  In addition, the more fully that an adolescent participated in a given therapy session, the more likely that in the subsequent session, the therapist and youth would have an extensive discussion about the journey from boyhood to manhood.  These results suggest that articulation of particular, culturally meaningful themes are directly linked to adolescent investment in the treatment process (Jackson-Gilfort & Liddle, in press). 

Resolving a Therapeutic Impasse Between Parents and Adolescent in MDFT

G. S. Diamond

Diamond and Liddle (1996, 1999) used task analysis to identify the combination of clinical interventions and family interactions necessary to resolve in-session impasses--conflicts characterized by negative exchanges, emotional disengagement, and poor problem-solving--between parents and adolescents.  The sample in this process study was drug involved teenagers and their families, referred mostly through juvenile justice sources, for drug treatment. Therapist behaviors that contributed to defusing these negative interactions included: (a) actively blocking, diverting, or addressing and working through negative affect; (b) implanting, evoking, and amplifying thoughts and feelings that promote constructive dialogue; (c) creating emotional treaties among family members by alternately working in session with parents alone and adolescents alone--a kind of shuttle diplomacy.  In cases with successful resolution of the impasse, the therapist transformed the parent? blaming and hopelessness by focusing on feelings of regret and loss, elicited the adolescent? thoughts and feelings about relationship roadblocks with the parent and others, directed new kinds of conversation between parent and adolescent in session, and amplified the parent? empathy by offering support and admiration.  These interventions facilitated personal disclosure by the adolescent and improved dialogue between family members.  Failure to resolve the impasse was more likely in families who were more conflicted and pessimistic.

Extant Parent and Youth Characteristics and Engagement in Adolescent Psychotherapy

G. Dakof

This study identified key demographic, parent, and adolescent pre-treatment characteristics that influenced engagement into outpatient drug abuse treatment. 224 primarily African American adolescents referred for drug treatment and their parents participated in this study. Data were gathered prior to treatment on demographic variables as well as on both parent and youth perspectives on youth, parent, and family functioning. A discriminant function analysis revealed that engagement in treatment is related to, in order of weighting, more positive parental expectations for their adolescent? educational achievement (SDF = .68), higher parental reports of youth externalizing symptoms (SDF = .59), and higher levels of family conflict perceived by the youth (SDF = .36).  Family income, gender, juvenile justice status, minority group status, family structure, mother, age and psychopathology, and treatment characteristics did not distinguish treatment engagers from non-engagers. The results suggest that both parent and youth perceptions are critical in engaging youth into psychotherapy.  These findings lead us to recommend adolescent engagement interventions focusing on both the youth and his or her parents, and suggest a content focus for adolescent engagement interventions.