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

In this study, the authors examined the relation between adolescent and parent therapeutic alliances and treatment outcome among 65 substance-abusing adolescents receiving multidimensional family therapy. Observer ratings of parent alliance predicted premature termination from treatment. Observer ratings, but not self-report, of adolescent alliance predicted adolescents' substance abuse and dependency symptoms at posttreatment, as well as days of cannabis use at 3-month follow-up. The association between adolescent alliance and substance abuse and dependency symptoms at posttreatment was moderated by the strength of the parent alliance. Results reveal the unique and interactive effects of the 2 alliances on treatment outcome and emphasize the need for a systemic and well-articulated approach to developing and maintaining the multiple alliances inherent to family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent and parent therapeutic alliances as predictors of dropout in multidimensional family therapy.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Piloting the Family Check-Up With Incarcerated Adolescents and Their Parents.

The purpose of the current investigation was to pilot the Family Check-Up (FCU; see T. J. Dishion & K. Kavanagh, 2003) with 10 incarcerated adolescents and their parents or guardians. The FCU is based on principles of motivational interviewing (W. R. Miller & S. Rollnick, 2002). The authors delivered FCU with a high degree of fidelity and adherence on the basis of ratings from parents, therapists, and observers. Results suggest that the FCU positively impacted families (effect sizes were generally in the medium range). After our intervention, adolescents were more confident in their ability to resist drug use, and parents were more confident in their ability to impact their adolescents' risky behaviors. Parents and adolescents both reported being highly satisfied with this intervention. These results warrant further investigation of the FCU with incarcerated adolescents and their families in a controlled clinical trial. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in couple and family therapy.

Couple and family therapy (CFT) is challenging because multiple interacting working alliances develop simultaneously and are heavily influenced by preexisting family dynamics. An original meta-analysis of 24 published CFT alliance-retention/outcome studies (k = 17 family and 7 couple studies; N = 1,416 clients) showed a weighted aggregate r = .26, z = 8.13 (p r = .24; z = 6.55, p r = .37; z = 6.16, p     

Integrative Borderline Adolescent Family Therapy: Meeting the Challenges of Treating Adolescents With Borderline Personality Disorder.

With the growing acceptance of the borderline personality disorder diagnosis for adolescents has come a need for specialized treatments for this challenging population. Further, because of the prominence of the family system during early and later adolescence, family treatments are particularly needed. The purpose of this article is to present the integrative borderline adolescent family therapy (I-BAFT) model that emerged from a National Institute on Drug Abuse-funded (Stage 1) treatment development and enhancement effort. I-BAFT integrates (a) key interventions from the family treatment of adolescent drug abuse (D. A. Santisteban et al., 2003; J. Szapocznik & W. Kurtines, 1989), (b) skills training shown effective with adults with borderline personality disorder (M. Linehan, 1993a) and adapted for adolescents, and (c) individual treatment interventions that promote motivation for treatment and enhance the integration of the 3 treatment components. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Potential Mediators of Cognitive-Behavioral Therapy for Adolescents With Comorbid Major Depression and Conduct Disorder.

Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire (S. D. Hollon & P. C. Kendall, 1980) appeared to mediate treatment effects on depressive symptoms. Therapeutic alliance by the 3rd session was higher among the CWD-A participants but did not predict reductions in depressive symptoms. Findings suggest that reducing negative thinking may be the primary mechanism through which the CWD-A intervention reduces depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Therapeutic Alliance in Cognitive-Behavioral Treatment of Children Referred for Oppositional, Aggressive, and Antisocial Behavior.

The authors examined the therapeutic alliance in evidence-based treatment for children (N = 185, 47 girls, 138 boys; ages 3-14 years) referred clinically for oppositional, aggressive, and antisocial behavior. Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at 2 points over the course of treatment. As predicted, both child-therapist and parent-therapist alliances related to therapeutic change, family experience of barriers to participation in treatment, and treatment acceptability. Greater alliance was associated with greater therapeutic change, fewer perceived barriers, and greater treatment acceptability. The findings could not be attributed to the influence of socioeconomic disadvantage, parent psychopathology and stress, and child dysfunction or to rater effects (common rater variance in the predictors and criteria). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy.

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent-Child Interaction Therapy With Physically Abusive Parents: Efficacy for Reducing Future Abuse Reports.

A randomized trial was conducted to test the efficacy and sufficiency of parent-child interaction therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive parents (N=110) were randomly assigned to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. Participants had multiple past child welfare reports, severe parent-to-child violence, low household income, and significant levels of depression, substance abuse, and antisocial behavior. At a median follow-up of 850 days, 19% of parents assigned to PCIT had a re-report for physical abuse compared with 49% of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent-child interactions, consistent with the PCIT change model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Personal Viewpoint on Training in Marital and Family Therapy.

In this article the author discusses some ideas about his philosophy of family therapy training, the place of the contextual approach in psychology, some of his experiences doing training in different settings, and some thoughts about national developments in family and marital therapy training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems.

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive- behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural Ecosystems Therapy for HIV-Seropositive African American Women: Effects on Psychological Distress, Family Hassles, and Family Support.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Association Between Patient Characteristics and the Therapeutic Alliance in Cognitive-Behavioral and Interpersonal Therapy for Bulimia Nervosa.

The therapeutic alliance is an established predictor of psychotherapy outcome. However, alliance research in the treatment of eating disorders has been scant, with even less attention paid to correlates of alliance development. The goal of this study was to examine the relation between specific patient characteristics and the development of the alliance in 2 different treatments for bulimia nervosa (BN). Data derive from a large, randomized clinical trial comparing cognitive- behavioral therapy (CBT) and interpersonal therapy (IPT) for BN. Across both treatments, patient expectation of improvement was positively associated with early- and middle-treatment alliance quality. In CBT, baseline symptom severity was negatively related to middle alliance. In IPT, more baseline interpersonal problems were associated with poorer alliance quality at midtreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How do therapists enhance family alliances? Sequential analyses of therapist-client behavior in two contrasting cases.

To identify alliance-related behavior patterns in more and less successful family therapy, the authors intensively analyzed two cases with highly discrepant outcomes. Both families were seen by the same experienced clinician. Results showed that participants' perceptions of the alliance, session impact, and improvement at three points in time were congruent with the families' differential outcomes and with observer-related alliance behavior using the System for Observing Family Therapy Alliances. In this measure, therapist behaviors contribute to the alliance and client behaviors reveal the strength of the alliance on four dimensions: Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family. In the poor outcome case, observer ratings and self-reported alliance scores revealed a persistently "split" alliance between family members; this family dropped out midtreatment. Only in the good outcome case did the clients follow the therapist's alliance-building interventions with positive alliance behaviors; sequential analyses showed that therapist contributions to Engagement significantly activated client Engagement behavior, and therapist Emotional Connection interventions significantly activated client Emotional Connection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family Communication and Religiosity Related to Substance Use and Sexual Behavior in Early Adolescence: A Test for Pathways Through Self-Control and Prototype Perceptions.

This research tested predictions about pathways to substance use and sexual behavior with a community sample of 297 African American adolescents (M age: 13.0 years). Structural modeling indicated that parent-adolescent communication had a path to unfavorable prototypes of substance users; quality of parent-adolescent relationship had paths to good self-control, higher resistance efficacy, and unfavorable prototypes of sexually active teens; and religiosity had inverse direct effects to both substance use and sexual behavior. Self-control constructs had paths to prototypes of abstainers, whereas risk taking had paths to prototypes of drug and sex engagers and direct effects to outcomes. Prototypes had paths to outcomes primarily through resistance efficacy and peer affiliations. Effects were also found for gender, parental education, and temperament characteristics. Implications for self-control theory and prevention research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting Stability and Change in Toddler Behavior Problems: Contributions of Maternal Behavior and Child Gender.

This study examined the stability and continuity of early-identified behavior problems and the factors associated with this stability. Children and their mothers (N=125) were seen when the children were 2 and 4 years of age. Maternal reports of child externalizing behavior and laboratory observations of child noncompliance were stable from age 2 to age 4. Early externalizing behaviors decreased over time; however, child noncompliance in the laboratory did not. Although few associations were found between maternal positive behavior and child behavior problems, maternal controlling behavior was related to increases in child behavior problems, particularly at high levels of both prior noncompliance and prior maternal control. Child noncompliance was predictive of increases in maternal controlling behavior over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change Process Research in Couple and Family Therapy: Methodological Challenges and Opportunities.

In our field, the study of therapeutic change processes lags behind the study of treatment efficacy. Nonetheless, in the past 10 years major strides have been made in delineating change process mechanisms in couple and family therapy. To focus the efforts of future change process researchers, the authors discuss 5 critical needs: (a) more well-articulated, midrange theory about systemic change processes; (b) more attention to client change processes; (c) more attention to covert intrapersonal processes (emotion, cognition, and clients' experience of the alliance); (d) better articulation of strategies for analyzing data from multiple participants; and (e) more focus on the degree to which various change processes work similarly (or not) for diverse couples and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An initial look at the outcomes for dynamic play therapy.

Recent reviews of play therapy have identified that inclusion of parents in the intervention improves outcomes. This article presents an initial study of the changes in problem behavior when children and their families are provided dynamic play therapy. Dynamic play therapy is a family intervention developed by the author in which families are helped to develop collaborative play together using art, drama, movement, storytelling, and video making. Results suggest that child behavior does improve, that parents report the development of a positive therapeutic alliance with the therapist, and that this alliance is associated with outcome. This study used an action research approach and was conducted in an ongoing child guidance clinic. Discussion of the limits and merits of this approach is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

System for observing family therapy alliances: A tool for research and practice.

To advance research and inform practice, the authors developed an observational rating system of client behavior reflecting strong and weak therapeutic alliances in couple and family therapy. The System for Observing Family Therapy Alliances (SOFTA), in both English and Spanish, has 2 dimensions that are common across therapy modalities ("emotional connection to the therapist" and "engagement in the therapeutic process") and 2 dimensions that reflect the uniqueness of conjoint treatment ("safety within the therapeutic system" and "shared sense of purpose within the family"). Psychometric support is provided by 5 reliability studies, an exploratory factor analysis with data from 120 diverse English- and Spanish-speaking couples and families, and meaningful associations with various process and outcome indices. Recommendations are made for using the SOFTA in research, training, and (self-)supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child-Related Disagreements, Verbal Aggression, and Children's Internalizing and Externalizing Behavior Problems.

Dual-income parents (N = 122 couples) with an oldest child 18-60 months of age completed the Child-Rearing Disagreements Scale (E. N. Jouriles et al., 1991), the Child Behavior Checklist (T. M. Achenbach & L. A. Rescorla, 2000), and the Verbal Aggression subscale of the Conflicts and Problem-Solving Scale (P. K. Kerig, 1996). Replicating the results of E. N. Jouriles et al. (1991) and extending these findings to daughters and fathers, the authors found links between child-related disagreements and parental ratings of child behavior problems in this low-risk sample. There were no links between fathers' reports of verbal aggression and child behavior problems. Among mothers, however, use of verbal aggression mediated the link between child-related disagreements and ratings of sons' internalizing problems. Verbal aggression did not moderate the link between child-related disagreements and child behavior problems for either mothers or for fathers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)