Therapy that includes parents is an effective, essential part of treatment for children's substance abuse and conduct disorders and emerging as an effective treatment for depression and anxiety disorders as well, according to a research review published in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry (Vol. 44, No. 9, pages 872-887).

Study authors Guy Diamond, PhD, director of the Center for Family Intervention Science at the Children's Hospital of Philadelphia, and Allan Josephson, MD, of the University of Louisville School of Medicine, examined every randomized clinical trial conducted in the last decade that included parents in the treatment of child and adolescent mental health disorders. Their review suggests family is key to treating substance abuse, depression and anxiety disorders. What's more, the review indicates it's effective in reducing academic and behavior problems in children with attention-deficit hyperactivity disorder when paired with other interventions, such as medication.

The findings counter many long-held notions within psychology and psychiatry that family therapy isn't productive because parents hinder treatment or use the time to defend their parenting, says Diamond.

"The misunderstanding of family therapy is that it's about blaming parents," he says. "Really, the approach is that families are the medicine. They are curative-if we can help them develop the right skills and postures."

He and Josephson also found that family therapy is "amazingly underutilized" in treating adolescents diagnosed with schizophrenia. Research shows that even the smallest amount of family involvement in schizophrenia treatment can reduce relapses by 50 percent, says Diamond.

Through their review, Diamond and Josephson also created a snapshot of modern family therapy. Today's family therapy, they say, includes a broad range of interventions and models for clinicians to choose from, and most models no longer require all family members to be present every time. What's more, parents can play a variety of roles: They can be co-therapists, sources of support or teachers of new skills, to name a few.

For example, he and Josephson found that two types of family-based treatments were particularly effective for conduct disorders-parent management training (PMT) and behavior family therapy (BFT). PMT teaches parents techniques to promote good behavior in their children, such as positive reinforcement. BFT builds on PMT to include reducing family stress that may be contributing to a child's disruptive behavior.

At the same time, the researchers argue, more studies are needed on which kinds of family interventions are most effective at different stages of a disorder and a child's development, and on the logistics of therapy and who's involved.

He and Josephson hope their findings prompt psychologists-many of whom are increasingly thinking in terms of treatment packages combining medication, cognitive-behavioral therapy and other interventions-not to overlook the benefits of parental involvement. They also call for more support from institutions such as the National Institute of Mental Health (NIMH). "Family can make the science complicated," Diamond acknowledges. "But I would like to see NIMH invest in this."

-J. Chamberlin