Core Elements of Family Therapy for Adolescent Behavior Problems: Empirical Distillation of Three Manualized Treatments

Abstract

Objective: Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments. Method: The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in one of three manualized family therapy models: Multidimensional Family Therapy (102 sessions/56 cases), Brief Strategic Family Therapy (100 sessions/94 cases), and Functional Family Therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White Non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian Structural Equation Modeling on the remaining half. Results: Factor analyses distilled four clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach's α = .93), Relational Reframe (7 techniques; α = .79), Adolescent Engagement (4 techniques; α = .68), and Relational Emphasis (4 techniques; α = .67). Conclusions: The four empirically derived factors represent the core elements of three manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings.

Fidelity Assessment of the Treatnet family (TF): A family-based intervention for adolescents with substance use disorders and their families

“…TF contains common elements of evidence-based family therapies and has been developed with a specific view for adolescents with SUD and their families in low and middle-income countries (LMIC) ( Hogue et al, 2019 , United Nations Office on Drugs and Crime (UNODC), 2019 ). TF focuses on family interactions and uses elements of family therapy to, among other things, change ineffective communication patterns within the family and learn more effective ones.…”

Measurement training and feedback system for implementation of evidence-based treatment for adolescent externalizing problems: protocol for a randomized trial of pragmatic clinician training

“…Germane to rigor, ITT-ABP items derive from a validated observational EBT fidelity tool for manualized treatments that has shown strong construct and predictive validity in studies of treatment fidelity and fidelity-outcome links [14] with youth samples including conduct-disordered, depressed, and substance-using teens. The FT scale [28] and CBT scale (Hogue A, et al, Core elements of CBT for adolescent conduct and substance use problems: developmental psychopathology, clinical techniques, and case examples; submitted) were each enhanced via a comprehensive distillation process to identify the respective core treatment techniques of each approach as evidenced in controlled research with manualized treatment models for AEPs. Study therapists will complete the FT items, CBT items, or both, depending on which EBT(s) they elect to train.…”

Engaging the Family in the Care of Young Adults With Substance Use Disorders

“…1,2 Recent evidence suggests that all three models can be distilled into four core practice elements: interactional change, relational reframe, adolescent engagement, and relational emphasis. 3 Each element includes specific techniques that a therapist can use to achieve reduction in substance use through improved family functioning. The interactional change element focuses on assessment of family dynamics and communication, so that therapists can provide guidance to family members on how to improve their interactions with their loved one with an SUD.…”

“…First, few therapists are trained in family therapy for SUDs. 3 Most current clinical models of care fail to involve family members routinely as therapeutic allies. Even if a program does offer services that include family members, young adults may choose not to include families as contacts.…”