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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:
The five assessment and intervention modules are
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. |
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