Therapist adherence in brief strategic family therapy for adolescent drug abusers.
OBJECTIVE
Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents who received brief strategic family therapy within a multisite effectiveness study.


METHODS
Participants were 480 adolescents (age 12-17) and their family members, who were randomized to the Brief Strategic Family Therapist treatment condition (J. Szapocznik, U. Hervis, & S. Schwartz, 2003) or treatment as usual. The adolescents were mostly male (377 vs. 103 female) and Hispanic (213), whereas 148 were White, and 110 were Black. Therapists were also randomly assigned to treatment condition within agencies.


RESULTS
Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use.


CONCLUSIONS
Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy.
Miller School of Medicine, University of Miami, USA. mrobbins@ori.org
Michael S
MS
Robbins
Daniel J
DJ
Feaster
Viviana E
VE
Horigian
Marc J
MJ
Puccinelli
Craig
C
Henderson
José
J
Szapocznik
D000293:Adolescent; D002648:Child; D005190:Family / Q000523:psychology; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D011614:Psychotherapy, Brief; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
Contemp Clin Trials. 2009 May;30(3):269-78
19470315
J Clin Child Adolesc Psychol. 2002 Jun;31(2):155-67
12056100
J Subst Abuse Treat. 2002 Jun;22(4):231-43
12072167
Am Psychol. 2008 Apr;63(3):146-59
18377105
Am J Addict. 2006;15 Suppl 1:102-12
17182425
J Consult Clin Psychol. 2000 Jun;68(3):451-67
10883562
J Fam Psychol. 2000 Dec;14(4):688-701
11132489
AIDS Behav. 2002 Jun;6(2):141-51
16715177
J Consult Clin Psychol. 2003 Oct;71(5):862-78
14516235
J Subst Abuse Treat. 2006 Jul;31(1):25-39
16814008
J Consult Clin Psychol. 1997 Oct;65(5):821-33
9337501
Psychol Methods. 2002 Mar;7(1):64-82
11928891
J Consult Clin Psychol. 2008 Aug;76(4):544-55
18665684
J Subst Abuse Treat. 2010 Jun;38 Suppl 1:S113-24
20307791
J Behav Ther Exp Psychiatry. 1992 Sep;23(3):183-9
1487536
J Subst Abuse Treat. 2009 Jan;36(1):25-43
18550320
J Marital Fam Ther. 2008 Jul;34(3):316-28
18717922
Fam Process. 2001 Fall;40(3):313-32
11676271
J Fam Psychol. 2006 Dec;20(4):535-43
17176187