Conceptual and clinical dimensions of a multidimensional, multisystems engagement strategy in family-based adolescent treatment.

Abstract

Therapy with adolescents challenges even the most skilled clinicians. Teenagers are difficult to engage in treatment, and the systems in which they are involved (schools, juvenile justice) frequently do not understand or support therapy's goals. Adolescents with behavior and drug problems live in families characterized by emotional estrangement or turmoil, sometimes both. Adolescents showing problems are involved with peer systems that are difficult for therapists to understand because of their secretive nature. Parents of these adolescents have generally not found previous attempts at seeking help useful or effective. In the face of these formidable challenges, therapists work in settings in which they must carry large caseloads, too often with inadequate This article is based on a paper by the author delivered at a symposium titled "Engaging Family Members in Drug Abuse Treatment" (E. Rahdert, Chair) at the 1994 American Psychological Association Annual Meeting in Los Angeles.

Adolescent and Parent Alliance and Treatment Outcome in Multidimensional Family Therapy.

“…Results suggest that, whereas the strength of the parent-therapist alliance appears to influence treatment completion, the strength of the alliance with the adolescent appears to impact on treatment outcome. Such findings underscore the importance of developing and disseminating specific and well-defined strategies for the formation and maintenance of each of these alliances (G. M. Diamond et al, 1999;Liddle, 1995Liddle, , 2002bLiddle & Diamond, 1991;Szapocznik et al, 1988), and of researching the effect of such alliance-building strategies.…”

“…Not only does this make alliance formation with this population more challenging but, ironically, it may also make it more critical to treatment outcome (Coatsworth, Santisteban, McBride, & Szapocznik, 2001;G. M. Diamond, Liddle, Hogue, & Dakof, 1999;Liddle, 1995;Liddle & Diamond, 1991;Shirk & Karver, 2003;Szapocznik et al, 1988). Indeed, Shirk and Karver (2003) found that the therapeutic relationship was more predictive of treatment success among children and adolescents with externalizing symptoms than those with internalizing symptoms.…”

“…They suggest that for treatment to be successful, the therapist must incorporate the adolescent's concerns and desires into the treatment process. It is only when the adolescent trusts that the therapist understands and acknowledges his or her trials and aspirations, and therapy is transformed into a personally meaningful endeavor, that treatment can be successful (Liddle, 1995). Most likely, each alliance bears some impact on one or more aspects of treatment outcome.…”

“…We predicted that each alliance would be associated with posttreatment levels of substance use and substance abuse and dependency symptoms, above and beyond the contribution of the other alliance. We also predicted, on the basis of MDFT theory (Liddle, 1995) and clinical experience, that the association between each alliance and adolescents' cannabis use and substance abuse and dependency symptoms would be moderated by the strength of the other alliance. More specifically, we predicted that the effect of a strong adolescent or parent alliance would be potentiated when the other alliance was of moderate or high strength.…”

The Development of a Depression Preventive Intervention for Adolescents with Attention-Deficit/Hyperactivity Disorder

“…In-vivo training where adolescents practiced problem-solving and interacting with their parents and other adolescents with guidance and feedback from staff was expected to generalize to child-parent interactions and thereby contribute to improving the parent-child relationship. In addition to providing in-vivo social skills reinforcement, the recreational activities served as a way to engage adolescents, a group that is often difficult to engage in treatment (Liddle, 1995). The expectation was that providing an active, less-traditional component in treatment would help adolescents "buy into" treatment and look forward to sessions.…”