Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.     

Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate knowns and unknowns regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.     

Haitian and Haitian American experiences of racism and socioethnic discrimination in Miami-Dade county: At-risk and court-involved youth

We examine how juvenile justice-involved youth of Haitian descent in Miami-Dade County cope with structural racism and its impact on their mental health. Drawing on longitudinal ethnography, psychosocial assessment data, and a family-based clinical intervention funded by the National Institute on Drug Abuse, this article explores youth narratives of discrimination prior to and during the COVID-19 pandemic. We use critical race theory and theory of practice to understand youths’ perceptions as racialized bodies and stigmatized selves, highlighting the experiences and perspectives of a particular black immigrant group, ethnic beings caught up in the everyday practices of racialization, sociocultural marginalization, and racism. We frame these experiences as a variation of the complex continuum of structural racism and racial domination in the US. These experiences have caused anger, fear, anxiety, chronic anticipatory distress, and hopelessness among youth of Haitian descent. We conclude with some recommendations for therapeutic support that encourages youth to process their experiences, promotes their development of a positive self-concept, and provides them with mind-body techniques to attenuate the physical impacts of discriminatory events. The clinical trial registration number for this study intervention is NCT03876171.     

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.     

The Integration of a Family Systems Approach for Understanding Youth Obesity,Physical Activity,and Dietary Programs

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.     

Therapist-Parent Interaction Patterns in Home-Based Treatments: Exploring Family Therapy Process

At the current stage of development in the family therapy field, exploratory, small-scale process studies are necessary in order to understand through what interpersonal processes child and family change occur. The goal of this article is to show how relevant therapist-parent interactions within family-based approaches can be explored and linked to the reduction in childrearing and behavior problems. Sequential analyses on 13 treatments using the Family Project Approach revealed that, within the most successful treatments, therapist and parent interact in a collaborative way in the phase of Direct Influence. In the beginning of this treatment phase, the therapist must activate the parents to tackle the problems actively. Further explorations indicated that a collaborative interaction pattern between therapist and mother during the first three sessions of therapy contributes to a better outcome.     

青少年的学校适应问题：家庭亲密度、家庭道德情绪和责任感的作用

随机选取某市三所普通中小学四、六、八、十年级的755名青少年为被试,使用自评和他评问卷探讨家庭亲密度、家庭道德情绪和责任感与青少年学校适应之间的关系。结果显示：（1）青少年家庭亲密度、责任感与学校适应问题存在性别差异,女生家庭亲密度和责任感高于男生,外化和学业问题少于男生;家庭亲密度、道德情绪和责任感随年龄增长呈下降趋势;（2）家庭亲密度正向预测道德情绪和责任感,直接和间接负向预测青少年学校适应问题。（3）责任感负向预测学校适应问题,并在家庭亲密度和学校适应问题之间起部分中介作用;结构方程模型各指标的拟合效果较好。家庭亲密度、责任感是学校适应问题的良好预测指标。     

Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment.

OBJECTIVE: Family-based treatments for pediatric obesity were developed over 25 years ago. Over that time, youth have become more obese and the environment more obesiogenic, which may influence efficacy of pediatric weight control. Mixed-effects regression models were used to compare the efficacy of programs initiated 20 to 25 years ago to current programs through 24-month follow-up, as well as to reanalyze 10-year outcomes of previous research using contemporary measures and analytic strategies. MAIN OUTCOME MEASURES: z-BMI and percent overweight. RESULTS: Results showed significant reductions over time, with no differences in z-BMI change for older versus contemporary studies. Age was a predictor of z-BMI up to 24 months, with younger children showing larger change. Mixed-effects regression models replicated previous long-term effects of family-based interventions. Gender was a predictor of long-term z-BMI change, with girls benefiting more over time than did boys. CONCLUSION: The efficacy of the family-based behavioral approach to treating pediatric obesity replicates over a 25-year period. Challenges in evaluating treatment effects over time are discussed. Ideas for studying choice of treatments that vary in effect size and for strengthening family-based behavioral treatments are noted.     

Family-level impact of the CHAMP Family Program: a community collaborative effort to support urban families and reduce youth HIV risk exposure

This article presents family-level results from an ongoing study examining the impact of the CHAMP (Chicago HIV prevention and Adolescent Mental health Project) Family Program, a family-based HIV preventative intervention meant to reduce the amount of time spent in situations of sexual possibility and delay initiation of sexual activity for urban youth in the 4th and 5th grades living in neighborhoods with high rates of HIV infection. The CHAMP Family Program has been developed, delivered, and overseen by a collaborative partnership, consisting of community parents, school staff, community-based agency representatives, and university-based researchers. Design of the program was informed by input from this collaborative partnership, child developmental theory of sexual risk, and empirical data gathered from the targeted community. This article presents findings that suggest CHAMP Family Program impact on family communication, family decision-making, and family-level influences hypothesized to be related to later adolescent HIV risk. Implications for future family-based HIV prevention research are discussed here.     

Scientist-practitioner family therapists, postmodern medical practitioners and expert parents: second-order change in the Eating Disorders Program at The Children's Hospital at Westmead

The Maudsley model of family-based treatment for anorexia integrates a variety of schools of family therapy, and has been developed and supported by a number of randomized controlled trials. In this paper we will describe the systemic organizational changes that have occurred as a result of the inclusion of this model in the Eating Disorders Program at The Children's Hospital at Westmead over an eighteen-month period, including a process of mutual influence between medical practitioners and family therapists. These changes have contributed towards a dramatic improvement in clinical outcomes including a significant drop in readmission rates to hospital.     

Comparison of the Family Therapy Educational and Experience Requirements for Licensure or Certification in Six Mental Health Disciplines

In a review of literature on clinical licensure programs and certified mental health disciplines, no studies specifically compared didactic methods and clinical training standards for family-based interventions. Consequently, consumers and insurers of these services have no basis from which to evaluate the relative competency of each of the mental health disciplines in providing family-based interventions. This study used content analysis to examine the amount of family based training that is required by six core mental health disciplines (Clinical Psychology, Psychiatry, Psychiatric Nursing, Professional Counseling, Marriage and Family Therapy, and Social Work) in each of the 50 United States. Results indicate that a marriage and family therapist is required to have three times more family therapy coursework than any other professional mental health discipline. Also, before becoming licensed a marriage and family therapist, must complete 16 times more face-to-face family therapy hours than a mental health professional from any other discipline. Implications for consumers and practitioners are discussed.     

Parental Involvement: Contribution to Childhood Anxiety and Its Treatment

Anxiety disorders are prevalent in youth. Despite demonstrated efficacy of cognitive behavioral therapy (CBT), approximately 40 % of anxiety-disordered youth remain unresponsive to treatment. Because developmental and etiological models suggest that parental factors are relevant to the onset and maintenance of childhood anxiety, researchers have proposed and investigated family-based interventions with increased parent work in treatment, aiming to improve the efficacy of treatment for childhood anxiety. However, contrary to what theoretical models suggest, data to date did not indicate additive benefit of family-based CBT in comparison with child-centered modality. Is parent/family involvement unnecessary when treating childhood anxiety disorders? Or could there be the need for specificity (tailored family-based treatment) that is guided by a revised conceptualization that improves the implementation of a family-based intervention? The current review examines (1) relevant parental factors that have been found to be associated with the development and maintenance of childhood anxiety and (2) interventions that incorporate parental involvement. Relevant findings are integrated to formulate a “targeted” treatment approach for parental involvement in CBT for youth anxiety. Specifically, there is potential in the assessment of parent/family factors prior to treatment (for appropriateness) followed by a target-oriented implementation of parent training.     

Separation-individuation theory and attachment theory

Separation-individuation and attachment theories are compared and assessed in the context of psychoanalytic developmental theory and their application to clinical work. As introduced by Margaret Mahler and John Bowlby, respectively, both theories were initially regarded as diverging from traditional views. Separation-individuation theory, though it has had to be corrected in important respects, and attachment theory, despite certain limitations, have nonetheless enriched psychoanalytic thought. Without attachment an infant would die, and with severely insecure attachment is at greater risk for serious disorders. Development depends on continued attachment to a responsive and responsible caregiver. Continued attachment to the primary object was regarded by Mahler as as intrinsic to the process of separation-individuation. Attachment theory does not account for the essential development of separateness, and separation-individuation is important for the promotion of autonomy, independence, and identity. Salient historical and theoretical issues are addressed, including the renewed interest in attachment theory and the related decline of interest in separation-individuation theory.     

Is manualized family‐based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at the end of treatment

Patient satisfaction with treatment sheds light on the acceptability, disseminability and usefulness of treatments. This study aimed to assess the perspectives of families who completed treatment using a manual-driven family-based treatment for anorexia nervosa. We hypothesized that overall, manualized treatment would be viewed as acceptable and helpful, but that none the less, a proportion of patients would identify a wish for other types or additional therapy. A total of thirty-four families participated in the survey. Results suggest that patients and families viewed the treatment as highly effective and acceptable. However, approximately a quarter suggested that individual therapy, more family therapy, and focusing on other issues besides anorexia nervosa would improve treatment. These data suggest that a manual-driven family-based treatment for adolescents with anorexia nervosa is acceptable to adolescents and their parents, though modifications to include additional therapy and individual therapy might be considered in some cases.     

Bridging theory and practice: conceptual understanding of treatments for children with attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), autism, and depression

Serves as an introduction to a special edition of the journal on bridging theory and clinical practice for childhood disorders. Issues concerning the current trend of developing and evaluating new treatments devoid of a theoretical perspective are discussed. A conceptual model of child psychopathology is presented to illustrate the relevance and interplay between theory and the design and evaluation of treatments with particular emphasis on the selection and measurement of target behaviors. The means by which theory and empirical evidence interact and their relevance to understanding particular childhood disorders are discussed and emphasize the need for theoretical and conceptual models that describe the linkages among hypothesized brain substrates, cognitive function, behavior, and the environment to augment the development of potent biological and psychological interventions.     

What Makes a Quality Therapy? A Consideration of Parsimony,Ease, and Efficiency

Evaluations of psychotherapy have traditionally focused on symptom reduction as the primary standard by which their value is determined. This has contributed to the appearance of equivalence between many therapies that may differ considerably in complexity, feasibility, amount of homework and therapist contact required, expected cost, speed of symptom decline, and transdiagnostic utility. In the current paper, I make the case that these are fundamental features related to quality that should be considered in psychotherapy development, randomized controlled trials, and dissemination efforts. Empirically supported treatments for different disorders are evaluated based on these criteria, and special consideration is given to cognitive-behavioral treatments for anxiety disorders. Specific recommendations for a quality-oriented clinical research agenda are also provided.     

On construct validity: issues of method and measurement

Fifty years ago, L. J. Cronbach and P. E. Meehl (1955) advocated for the concept of construct validity, noting that psychologists study hypothetical, inferred entities and that validating measures of such entities involves basic theory testing. Three important developments in clinical assessment following that seminal article are noteworthy. First, clinical research has benefited from greater theoretical integration and subsequent differentiation among related constructs. Second, implementation of ongoing, critical evaluation of all aspects of the construct validity process, including theory development, hypothesis specification, research design, and empirical evaluation, has improved clinical assessment. Third, improvement in evaluating fit between hypotheses and observations has been sought. Improved means of evaluating multitrait, multimethod designs, and ways to increase their clinical representativeness, are one encouraging development. Ongoing efforts to improve the construct validity process reflect the legacy of L. J. Cronbach and P. E. Meehl.     

Attachment and family therapy: clinical utility of adolescent-family attachment research

The divide separating research and clinical work is narrowing. New therapies have been informed by research from specialties such as developmental psychology and developmental psychopathology. In this article, we attempt to illustrate the usefulness of research on attachment relations for family-based therapy with adolescents. We examine the clinical utility of adolescent attachment research within the context of multidimensional family therapy, an empirically supported treatment model that has incorporated developmental research, including basic research on attachment, in its assessment and intervention framework.     

Early Intervention of Eating- and Weight-Related Problems

Obesity and other eating-related problems are widespread and are associated with harmful physical, psychological, and social problems. The dramatic increases in rates of pediatric obesity has created a mounting need for psychologists and other mental health care providers to play a significant role in the assessment and treatment of youth with eating- and weight-related problems. Therefore, it is imperative for providers to be aware of the causes and consequences of eating- and weight-related problems and to be familiar with evidence-based assessment and intervention approaches. Currently, the most well-established intervention approaches are family-based behavioral treatments, and weight loss maintenance treatments with a socio-ecological focus are promising. This paper provides a comprehensive review of these topics and highlights the important roles that mental health care providers can have. Medical settings are often the patient’s first point of contact within the healthcare system, making mental health care providers in such settings uniquely suited to assess for a broad range of eating- and weight-related problems and associated comorbidities, to deliver relevant evidence-based interventions, and to make appropriate referrals. Moving forward, providers and researchers must work together to address key questions related to the nature of eating- and weight-related problems in youth and to achieve breakthroughs in the prevention and treatment of such problems in this vulnerable population.     

促进当事人的改变：基于治疗性最近发展区的视角

作为心理治疗的有效区域,治疗性最近发展区是指当事人当前适应问题经验的能力和通过治疗师的协助能够达成的潜在能力之间的距离。早期的同化模型理论更注重对心理治疗改变过程的描述,治疗性最近发展区理论则能够进一步解释治疗师在不同阶段的帮助策略。在研究上,治疗性最近发展区理论建立在非传统的方法论基础上,通过不断累积个案的质性研究,帮助治疗师理解和解释不同咨询效果的互动过程,并使理论得到持续发展;在临床上,治疗性最近发展区为理解心理治疗过程中倒退现象提供了新视角,并能够有效指导在治疗过程中采取挑战性还是支持性策略。未来研究可从临床上探索经验丰富的治疗师的实践智慧,也可选取较大跨度的治疗对话序列,对不同流派的特点,从不同参与者的视角出发进行研究,进而深化对心理治疗过程机制的理解。