title: Parallel demand-withdraw processes in family therapy for adolescent drug abuse.
abstract: Isomorphism, or parallel process, occurs in family therapy when patterns of therapist-client interaction replicate problematic interaction patterns within the family. This study investigated parallel demand-withdraw processes in brief strategic family therapy (BSFT) for adolescent drug abuse, hypothesizing that therapist-demand/adolescent-withdraw interaction (TD/AW) cycles observed early in treatment would predict poor adolescent outcomes at follow-up for families who exhibited entrenched parent-demand/adolescent-withdraw interaction (PD/AW) before treatment began. Participants were 91 families who received at least four sessions of BSFT in a multisite clinical trial on adolescent drug abuse (Robbins et al., 2011). Prior to receiving therapy, families completed videotaped family interaction tasks from which trained observers coded PD/AW. Another team of raters coded TD/AW during two early BSFT sessions. The main dependent variable was the number of drug-use days that adolescents reported in timeline follow-back interviews 7 to 12 months after family therapy began. Zero-inflated Poisson regression analyses supported the main hypothesis, showing that PD/AW and TD/AW interacted to predict adolescent drug use at follow-up. For adolescents in high PD/AW families, higher levels of TD/AW predicted significant increases in drug use at follow-up, whereas for low PD/AW families, TD/AW and follow-up drug use were unrelated. Results suggest that attending to parallel demand-withdraw processes in parent-adolescent and therapist-adolescent dyads may be useful in family therapy for substance-using adolescents.
authors: Center on Alcoholism, Substance Abuse, and Addictions (CASAA).
authors: Kristina N
authors: KN
authors: Rynes
authors: Department of Psychology, University of Arizona.
authors: Michael J
authors: MJ
authors: Rohrbaugh
authors: Department of Psychology, University of Arizona.
authors: Florencia
authors: F
authors: Lebensohn-Chialvo
authors: Department of Psychology, University of Arizona.
authors: Varda
authors: V
authors: Shoham
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010287:Parent-Child Relations; D010290:Parents; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D011614:Psychotherapy, Brief; D012044:Regression Analysis; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome