Multidimensional Family Therapy
For individuals in the U.S. & U.S. territories
In Multidimensional Family Therapy, Dr. Howard A. Liddle demonstrates this integrative, empirically supported approach for working with families of adolescents with behavior and substance abuse problems. Multidimensional family therapy (MDFT) protocols guide therapists in assessing and intervening simultaneously in developmentally critical domains of a teen's and family's life. Emotions, cognitive processes, and behavior are interconnected and are all addressed in MDFT. Adolescent problems such as drug abuse and delinquency are multidimensional in etiology and current manifestation, and therefore attempted remedies and therapist behavior must be multidimensional as well.
As a multisystems model, MDFT clinicians work individually with the adolescent and the parent, with the family as a whole to facilitate new relationships, and with family members in relation to sources of ongoing influence such as school and juvenile justice systems to address current functioning and new solutions for the adolescent.
In this session, Dr. Liddle works with a 15-year-old boy, recently diagnosed with ADHD and depression, who seeks a better relationship with his father. Dr. Liddle meets with the adolescent client and his mother to help them move beyond previous therapy to make changes in their lives.
Multidimensional family therapy (MDFT) is a family-based treatment developed for adolescents with drug and behavior problems. MDFT evolved over the past 17 years within a National Institute on Drug Abuse-funded research program designed to develop and evaluate family-based drug abuse treatment for adolescents. This approach has been recognized as one of a new generation of multicomponent, theoretically derived, and empirically supported drug abuse treatments for adolescents. This multidimensional perspective seeks symptom reduction and enhancement of prosocial and appropriate developmental functions by facilitating adaptive developmental events and processes in several domains of functioning.
The treatment seeks to significantly reduce or eliminate the adolescent's substance abuse and other problem behavior, and to improve overall family functioning.
Objectives for the adolescent include transformation of a drug-using lifestyle into a developmentally normative lifestyle and improved functioning in several developmental domains, including positive peer relations, healthy identity formation, bonding to school and other prosocial institutions, and a developmentally on-target balance between increased autonomy and emotional connection within the parent–adolescent relationship.
For the parents, objectives include facilitating parental commitment and emotional investment; improving the overall relationship and day-to-day communication between parent and adolescent; increased knowledge about and changes in parenting practices (e.g., limit-setting, monitoring, appropriate autonomy granting); and attention to the other functioning and needs of the parents.
The treatment approach has multiple components, and assessment and intervention occurs in several core areas of the teen's life simultaneously.
The MDFT model has been applied in a variety of community-based clinical settings targeting a range of populations. These clinical groups have comprised ethnically (White, African American, and Hispanic) and linguistically (Spanish and English) diverse adolescents at risk for abuse or abusing substances; the groups have included these adolescents' families. The parents of adolescents targeted in MDFT controlled studies have had a range of economic and educational levels. Adolescents treated in MDFT trials have ranged from high-risk early adolescents, to multiproblem, juvenile justice-involved, dually diagnosed female and male adolescent substance abusers.
By design, the MDFT approach has been developed and tested in different forms or versions, making it a uniquely flexible approach. The different forms of MDFT are applied according to the clinical needs of the target population and clinical setting. Sessions may occur multiple times during the week, in a variety of contexts including the home, the MDFT clinic, community settings such as schools or courts, or by phone.
Five assessment and intervention modules structure the MDFT approach. Session content and foci vary by the stage of treatment, but core content or focus, derived from the developmental literature on the most important functional areas to target, is worked with each case (e.g., adolescent's developmental tasks and concerns, peer relations, involvement in legal and juvenile justice systems, drug use as a way of coping with circumstances or psychological status).
The three treatment stages are as follows:
- stage 1, build the foundation
- stage 2, work the themes
- stage 3, seal the changes and exit
The five assessment and intervention modules are
- interventions with the adolescent
- interventions with the parent
- interventions to change the parent–adolescent interaction
- interventions with other family members
- interventions with systems external to the family
A multiple systems-oriented and developmentally focused therapy, MDFT targets the known areas of risk associated with adolescent drug abuse and delinquency and enhances those protective factors and processes known to promote successful teen and family development.
To further the development of MDFT, Dr. Liddle has engaged in a systematic program of process research aimed at uncovering the primary mechanisms of change within the model. These studies have helped to illuminate the interior of treatment, and hence there are now empirical clues about why MDFT is effective.
An example includes the MDFT process studies on the therapeutic alliance. Studies have established a link between the quality of the two interdependent but individual therapeutic alliances between the therapist and the teenagers, and the therapist and the parent, and engagement and retention in treatment. Other studies have determined the best methods to establish effective therapeutic alliances with the adolescent and the parent, how to transform in-session therapeutic stalemates between parents and teens into productive discussions, how to change parenting behaviors and improve the overall psychosocial functioning of the teen's parent, and how to enhance the treatment engagement of teens using culturally specific interventions.
Howard A. Liddle, EdD, ABPP (Family Psychology), received his doctorate in education in 1974 at Northern Illinois University. He is director of the Center for Treatment Research on Adolescent Drug Abuse and professor in the departments of epidemiology and public health, psychology, and counseling psychology at the University of Miami Miller School of Medicine.
His research program began in 1985 and addresses the development, testing, refinement, and dissemination of a family-based treatment for adolescent substance abuse. This treatment model, multidimensional family therapy (MDFT), has been recognized as an "exemplary" or "best practice" model by the Center for Substance Abuse Prevention, the Office of Juvenile Justice and Delinquency Prevention's "Strengthening Families" initiative, and as an empirically supported treatment in both the National Institute on Drug Abuse (NIDA) publication, Principles of Effective Drug Treatment, and the Center for Substance Abuse Treatment's Treatment Improvement Protocol Series volume, Adolescent Substance Abuse. MDFT has been transported to clinics around the U.S. and in six European countries.
Dr. Liddle was the founding editor of the Journal of Family Psychology in 1987, and he is also known for his work in the family therapy training and supervision area. His 1988 book, Handbook of Family Therapy Training and Supervision, remains a classic textbook in that specialty.
- Adolescent Substance Abuse: An Interview with Howard A. Liddle, EdD. (2001, February 21). Retrieved May 1, 2008, from http://www.athealth.com/practitioner/particles/interview_howardliddle.html.
- Liddle, H. A. (2004). Family-based therapies for adolescent alcohol and drug use: Research contributions and future research needs. Addiction, 99 (Suppl. 2), 76–92.
- Liddle, H. A., Rowe, C. L., Gonzalez, A., Henderson, C. E., Dakof, G. A., & Greenbaum, P. E. (2006). Changing provider practices, program environment, and improving outcomes by transporting multidimensional family therapy to an adolescent drug treatment setting. The American Journal on Addictions, 15, 102–112.
- Liddle, H. A. (2009). Multidimensional family therapy: A science-based treatment system for adolescent drug and behavior problems. In J. Bray & M. Stanton (Eds.), Blackwell handbook of family psychology. London: Blackwell.
- Liddle, H. A., Rowe, C. L., Quille, T. J., Dakof, G. A., Mills, D. S., Sakran, E., & Biaggi, H. (2002). Transporting a research-based adolescent drug treatment into practice. Journal of Substance Abuse Treatment, 22, 231–243.
- Liddle, H. A., Jackson-Gilfort, A., & Marvel, F. A. (2006). An empirically supported and culturally specific engagement and intervention strategy for African American adolescent males. American Journal of Orthopsychiatry, 75 (2), 215–225.
- Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2005). Adolescent and parent alliance and treatment outcome in multidimensional family therapy. Journal of Consulting and Clinical Psychology, 73 (4), 689–698.
- Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C., & Greenbaum, P. (in press). Multidimensional family therapy for early adolescent substance abusers: Twelve month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology.
- Liddle, H. A., Dakof, G. A., Turner, R. M., Henderson, C. E., & Greenbaum, P. E. (in press). Treating adolescent drug abuse: A randomized trial comparing multidimensional family therapy and cognitive–behavior therapy. Addiction.
- Marvel F. A., Rowe, C. R., Colon, L. DiClemente, R., & Liddle, H. A. (in press). Multidimensional family therapy HIV/STD risk-reduction intervention: An integrative family-based model for drug-involved juvenile offenders. Family Process.
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