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This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent and adolescent) and family levels (within-family differences). Participants were 34 families who received functional family therapy for the treatment of adolescent (aged 12-18 years) behavior problems. Families were classified as treatment dropouts (n=14) or completers (n=20). Videotapes of the first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that individual parent and adolescent alliances did not predict retention. However, as hypothesized, dropout cases had significantly higher unbalanced alliances (parent minus adolescent) than did completer cases. These findings highlight the importance of alliances in functional family therapy and suggest that how the alliance operates in conjoint family therapy may be a function of systemic rather than of individual processes.

Attachment-Based Family Th erapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression. Th is book describes clinical strategies for therapists, as well as the theoretical basis of the approach and the evidence base that supports it. ABFT emerges from interpersonal theories that suggest adolescent depression and suicide can be precipitated, exacerbated, or buff ered against by the quality of interpersonal relationships in families. ABFT organizes the therapy around tasks that repair interpersonal ruptures and rebuild an emotionally protective, secure-based, parent-child relationship. Th e treatment initially focuses on repairing or strengthening attachment and then turns to promoting adolescent autonomy. 2014. 280 pages. Hardcover.

Objective To determine the effectiveness of brief strategic family therapy (BSFT; an evidence-based family therapy) compared to treatment as usual (TAU) as provided in community-based adolescent outpatient drug abuse programs. Method A randomized effectiveness trial in the National Drug Abuse Treatment Clinical Trials Network compared BSFT to TAU with a multiethnic sample of adolescents (213 Hispanic, 148 White, and 110 Black) referred for drug abuse treatment at 8 community treatment agencies nationwide. Randomization encompassed both adolescents’ families (n = 480) and the agency therapists (n = 49) who provided either TAU or BSFT services. The primary outcome was adolescent drug use, assessed monthly via adolescent self-report and urinalysis for up to 1 year post randomization. Secondary outcomes included treatment engagement (≥2 sessions), retention (≥8 sessions), and participants’ reports of family functioning 4, 8, and 12 months following randomization. Results No overall differences between conditions were observed in the trajectories of self-reports of adolescent drug use. However, the median number of days of self-reported drug use was significantly higher, χ2(1) = 5.40, p < .02, in TAU (Mdn = 3.5, interquartile range [IQR] = 11) than BSFT (Mdn = 2, IQR = 9) at the final observation point. BSFT was significantly more effective than TAU in engaging, χ2(1) = 11.33, p < .001, and retaining, χ2(1) = 5.66, p < .02, family members in treatment and in improving parent reports of family functioning, χ2(2) = 9.10, p < .011. Conclusions We discuss challenges in treatment implementation in community settings and provide recommendations for further research.

This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Waldron and Turner (2008). It first summarizes the Waldron and Turner findings as well as those from more recent literature reviews and meta-analytic studies of ASU treatment. It then presents study design and methods criteria used to select 19 comparative studies subjected to Journal of Clinical Child & Adolescent Psychology level of support evaluation. These 19 studies are grouped by study category (efficacy or effectiveness) and described for sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach: ecological family-based treatment, group cognitive-behavioral therapy, and individual cognitive-behavioral therapy are deemed Well Established; behavioral family-based treatment and motivational interviewing are deemed Probably Efficacious; drug counseling is deemed Possibly Efficacious; and four integrated treatment models combining more than one approach are deemed Well Established or Probably Efficacious. The remainder of the article (a) articulates fidelity, mediator, and moderator effects reported for evidence-based approaches since 2008 and (b) recommends four enhancements to the prevailing business model of ASU outpatient services to accelerate penetration of evidence-based approaches into the underserved consumer base: pursue partnerships with influential governmental systems, utilize web-based technology to extend reach and control costs, adapt effective methods for linking services across sectors of care, and promote uptake and sustainability by emphasizing return on investment. INTRODUCTIONThis article reviews the evidence base on outpatient behavioral treatments for adolescent substance use (Turner, Muck, Muck, Stephens, & Sukumar, 2004). Because practice guidelines in behavioral healthcare now favor on-site treatment over referral for comorbid disorders (see Sacks et al., 2013), behavioral therapists should be fully prepared to manage common ASU problems that present as a secondary reason for referral or an emergent treatment issue. Thus for behavioral health providers who serve teenage populations in a variety of settings, identifying effective treatments for ASU remains a top priority.The following two sections specify the area of intervention science surveyed in this update and recap the Waldron and Turner (2008) findings that are the launching point for review. The remainder of the article summarizes findings from other literature reviews and meta-analytic studies of ASU treatment published since 2008 and introduces the main contributions of the current review; defines the search parameters and inclusion criteria for identifying the final pool of 19 comparative studies subjected to the JCCAP evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014); describes the main findings of these ...

The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response.

This study tests the efficacy of Structural Ecosystems Therapy (SET), a family-ecological intervention, in improving psychosocial functioning when compared with an attention-comparison person-centered condition and a community control condition. A sample of 209 HIV-seropositive, urban, low-income, African American women was randomized into 1 of the 3 conditions. Results of growth curve analyses over 5 time points revealed that SET was more efficacious than either of the control conditions in reducing psychological distress and family-related hassles. However, contrary to hypotheses, SET was not more efficacious in increasing family support. Latent growth mixture modeling analyses indicated that SET was most efficacious for women who, on average, were at or near the clinical threshold for psychological distress and for women with high levels of family hassles. Implications for further intervention development are discussed.

Observationally based coding systems represent one major source of information regarding the process of family therapy, the nature of change mechanisms, and the necessary components of intervention manuals. In this article, the authors introduce a two-dimensional framework for organizing the diverse approaches to observational coding that currently exist. These dimensions focus on the information used in identifying the coding unit and the degree of inference involved in assigning a code (i.e., meaning) to that unit. The goal in developing this framework is to provide a common basis on which observationally based family therapy process research initiatives can be developed, compared, and integrated.Family therapy process research has not only come of age-it is thriving! In addition to consistent representation in major journals, several major reviews and proposed models have dealt with issues of context (