Multidimensional Family Therapy for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT ...

247 Pages·2012·5.71 MB·English

DOCUMENT RESUME
CG 032 484
ED 478 685
Liddle, Howard A.
AUTHOR
Multidimensional Family Therapy for Adolescent Cannabis
TITLE
Users, Cannabis Youth Tr6atment (CYT) Series, Volume 5
Substance Abuse and Mental Health Services Administration
INSTITUTION
(DHHS/PHS), Rockville, MD. Center for Substance Abuse
Treatment.
SMA-02-3660
REPORT NO
2002-00-00
PUB DATE
032
246p.; For Volume 1, see CG 032 480; for Volume 2, see CG
NOTE
481; for Volume 3, see CG 032 482; for Volume 4, see CG 032
483
T111323;270-99-7072
CONTRACT
For full text: http://www.kap.samhsa.gov/products/
AVAILABLE FROM
manuals/cyt/.
Information Analyses (070)
Guides - Non-Classroom (055)
PUB TYPE
Descriptive (141)
Reports
EDRS Price MF01/PC10 Plus Postage.
EDRS PRICE
*Adolescents; *Behavior Modification; *Cognitive
DESCRIPTORS
Restructuring; Counseling Effectiveness; Counseling
Techniques; Drug Rehabilitation; Family Counseling; *Family
Relationship; Intervention; *Marijuana; Models; Outcomes of
Treatment; Reinforcement; Substance Abuse; Theory Practice
Relationship
*Family Therapy; *Multidimensional Models
IDENTIFIERS
ABSTRACT
The purpose of the Substance Abuse and Mental Health Services
Cannabis
Administration's Center for Substance Abuse Treatment's (CSAT's)
test the relative
Youth Treatment (CYT) Project Cooperative Agreement was to
designed
effectiveness and cost-effectiveness of a variety of interventions
in adolescents and to
to eliminate marijuana use and associated problems
field. The
provide validated models of these interventions to the treatment
disorders of abuse or
target population was adolescents with cannabis use
(1994), who
dependence, as defined by the American Psychiatric Association
in outpatient settings. This
were assessed as appropriate for treatment
multidimensional
manual guides therapists and their supervisors in using the
family therapy intervention with adolescents and their caregivers.
treatment
Multidimensional family therapy is the multisystemic family-focused
that includes 12
described in this manual for experienced family therapists
individual adolescents
weeks of in-clinic and telephone sessions working with
of individual
and their families. MDFT targets the psychosocial functioning
influential social
family members, the family members' relationships, and
and a
systems outside the family. The approach strives for consistency
of intervention,
coherent and logical connection among its theory, principles
methods derive from
and intervention strategies and methods. The intervention
research-based
target population characteristics, and they are guided by
development.
knowledge about dysfunctional and normal adolescent and family
Interventions work within the multiple ecologies of adolescent development,
drug taking
and they target the processes known to produce and/or maintain
and related problem behaviors. Appendixes include key terms and
Reproductions supplied by EDRS are the best that can be made
from the original document
abbreviations, administrative issues in implementing MDFT, a summary of the
MDFT research program, and a detailed account of the CYT study. (Contains 265
references.)
(GCP)
Reproductions supplied by EDRS are the best that can be made
from the original document.
Multidimensional Family Therapy
For Adolescent Cannabis Users
1.11
00
00
r--
Cannabis Youth Treatment Series
Volume 5
U.S. DEPARTMENT OF EDUCATION
Office of Educational Research and Improvement
EDUCATIONAL RESOURCES INFORMATION
CENTER (ERIC)
This document has been reproduced as
received from the person or organization
originating it.
Minor changes have been made to
improve reproduction quality.
Points of view or opinions stated in this
document do not necessarily represent
official OERI position or policy.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov
)3EST COPY AVAILABLE
2
Multidimensional
Znerapy' for
y
A olescent Cannabis -Users
Howard A. Liddle, Ed.D.
CYT
reafinent Series
Caimabis Yo u&
Volume 5
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Rockwall II, 5600 Fishers Lane
Rockville, MD 20857
3
Acknowledgments
Numerous people contributed to this document, which is part of the Cannabis
Youth Treatment (CYT) Project Cooperative Agreement. The document was written
by Howard A. "Addle, Ed.D. (University of Miami School of Medicine). The
Children's HOspital of Philadelphia (CHOP) staff, University of Miami Center for
Treatment Research in Adolescent Drug Abuse staff, and the Steering Committee
(Thomas Babor, Michael Dennis, Guy Diamond, Jean Donaldson, Jim Herrell, Susan
H. Godley, Frank Tirns, Charles Webb, and William White) provided valuable guidance
and support on this document. Significant contributions to the MDFT approach
have been made by Dana Becker, Gayle Dakof, Gary Diamond, Guy Diamond, Aaron
Hogue, Tanya Quille, and Cindy Rowe.
Disclaimer
This report was developed with support from the Center for Substance Abuse
Treatment (CSAT) to CHOP through Grant No.
The report was produced
T111323.
Johnson, Bassin K Shaw, Inc., under Contract No. 270-99-7072 with the
Iry
Substance Abuse and Mental Health Services Administration (SAMHSA), U.S.
I.)epartment of Health and Human Services (DIMS). Karl D. White, Ed.D., served as
the CSAT Knowledge Application Program (KAP) Project Officer; Jean. Donaldson,
M.A.., as CSAT CYT Project Officer. The content of this publication does not
necessarily reflect the views or policies of CSAT, S.AMIISA, or DIMS.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced
or copied without permission from SAMHSA or CSAT. Citation of the source is
appreciated. However, this publication may not be reproduced or distributed for a
fee without the specific, written authorization of the Office of Communications,
SAMHSA, DHHS.
Electronic Access and Copies of Publication
This publication can be accessed electronically through the following Internet
World Wide Web connection: www.samhsa.gov/. For additional copies of this document,
please call SAMHSA's National Clearinghouse for Alcohol and Drug Information at
800-729-6686 or 800-487-4889 (TDD).
Recommended Citation
Liddle, H.A. Multidimensional Family Therapy .for Adolescent Cannabis Users,
Cannabis Youth. Treatment Series, Volume 5. DIMS Pub. No.
Rockville, MI):
02-3660
Center for Substance Abuse Treatment, Substance Abuse and Mental Health
Services Administration,
2002.
.
Originating Office
Office of Evaluation, Scientific Analysis and Synthesis, Center for Substance Abuse
Treatment, Substance Abuse and Mental Health Services Administration, 5600
Fishers Lane, Rock Ville, MD 20857.
DIMS Publication No. (SMA) 02-3660
Printed 2002
Cover images ©2000 Digital Stock.
1 Ale of Contents
Background on the. Crf Cooperative Agreement
Goals and Objectives
Overview of the Study
1
Expected Products
MDFT' Approach to Cannabis Treatment
3
Evolution of the MDFT Protocol
3
Overview of the Treatment Model Intervention
4
Dimensions of Multidimensional Family Therapy
5
Outcome
5
Process
5
Development
6
Problem Behaviors
6
Ecology
6
Psychotherapy
6
Family Therapy
6
Treatment. Parameters
Defining the Clinical Model in the CSATCYT Multisite Project
.7
.
General Theoretical Assumptions and Approach
Theory of Dysfunction
Risk factors
S
Protective factors
9
Adolescent development
9
Theory of Change
11
Principles of Multidimensional Family-Therapy
14
Basic Requirements for Clinics Offering MDFT
16
Treatment Locale
16
Treatment Duration and Intensity
17
Nature of Clinical Contact
17
Staffing Requirements
17
Clinical Supervision Requirements
18
Overview: The Three Stages of the MDFT Treatment Program
.1.8
.
.
Stage One: Build the Foundation
18
Stage Two: Prompt Action and Change by Working the
Themes
23
Stage Three: Seal the Changes and Exit
27
98
Modules Are Intervention Targets
29
Whole and Part Thinking
29
Multiple Domains of Simultaneous Intervention
30
Interventions With an Adolescent
31
Interventions With Parents and Other Family Members
Interventions with parents
31
Interventions with other family members
31
Interventions To Change th.e ParentAdolescent Interaction.
.32
Interventions With Systems External to the Family
33
Therapeutic Case Management
33
5
Multidimensional Family Therapy for Adolescent Cannabis Users
MDFT Sessions: Operational Features of the Approach
39
III.
The Three Stages of Treatment: An Indepth View
39
Stage One: Build the Foundation
39
Engaging the adolescent
39
Engaging parents
43
Stage Two: Work the Themes
45.
Key themes
45
Therapist guidelines in working the themes
45
Dealing with the past in a present-centered therapy
46
Stage Three: Seal the Changes and Exit
47
Goals, Rationale, and Procedures of MDFT Interventions
49
IV.
Key Concepts of MDFT Interventions
49
Multidimensionality
49
Redefining Sessions
Multiple Therapeutic Alliances
Linking
Continuity
WholePart (Holon) Thinking
5.1
Doing 'What It Takes
5.1
"Parental Hell"
51
Working All Four Corners
52
What You Don't Know CAN Hurt You
52
Organizing According to Modules and Stages
53
Goals and Themes Emerge From the Interaction of the
Generic and the Idiosyncratic
53
Culturally Sensitive Treatment
54
The Adolescent Subsystem Module
54
Adolescent Engagement Interventions
62
Case Example: There Is Something in This for You
65
Clinical Guidelines: Dealing With Drugs in M.DFT
70
MDFT, Drug Abuse, and Standard Family Therapy Practice
70
MDFT, Drug AbuSe, and a Chemical Dependency Model
How To Deal With. Drug Use and Abuse
72
In- Session. Interventions Pertaining to Drug Use
73
Practical Guidelines for the Use of Urinalysis in MDII'
77
Use of 1.2-Step Fellowships in MDFT
84
Case Example: Dealing With Drug Use Directly in Session
86
MDFT With Adolescent Girls
.92
Cultural Theme Interventions
93
Risky Sexual Behavior Interventions
97
Multimedia Interventions
99
Spirituality
101
Psychiatric Consultation and Psych.otropie
Medication Management
101
The Parents and Other Family Members Subsystem MOdule
105
Parenting Relationship Interventions
107
Parenting Styles and Practices Interventions
110
Interventions With Other Family Members
111
The Family Interaction Module
:112
Case Example: I Want My Daughter Back
114
rig
Table of Contents
Therapist Improvisation: Shifting Domains of Operation
114
Intentional and Unintentional Shifts in a Session
116
Case Example: Building a Relationship Bridge
119
Extrafamilial Module
128
Interventions in Relation to the Peer Network:
The Ecomap Method
130
Interventions To Improve School Behavior and Academic
and Vocational Functioning
136
Intervention Guidelines To Improve School Behavior and
Academic and Vocational Functioning of Drug-Involved
Youth
142
Decision making
144
Collaborating With the Juvenile Justice System:
Probation Officers
146
The interaction and interdependence of mtwr and
the juvenile justice system
148
A collaborative, purposeful, youth-oriented alliance
148
Additional Collaborations With the Juvenile Justice System:
The Important Subsystem of the Juvenile Court Judges
1149
. .
Repercussions of Lack of Involvement in Extrafamilial
Subsystems
152
Working the Model: The Interdependence of Emotions and
V
Cognitions in MDFT
155
Negative Emotions and Problem Behaviors
155
Emotions and Problem Solving
156
Emotions and Dysfunctional Family Patterns
156
Case Example: Escalating Negative Emotion
157
Segment Introduction
157
Segment One (Baseline): Negative Emotion in Action
158
Segment Two: Focus and Framing
159
Segment. Three: Emotions Inform Theme Development
161
Segment Four: Working an Emotion-Related Theme and the
Interrelationship of Empathy and Construetivism
163
Segment Five: Using an Out-of-Session Crisis To Work a Core
Interpersonal Theme
164
Segment Six: In-Session Outcome
169
Procedural Steps: Implementing, MINTFacilitating Key
VI.
Therapeutic Processes
173
173
Establishing Priorities and Making Decisions
Therapeutic Alliance
173
Linking as a Mechanism of Change
174
Use of Self by the Therapist
174
Incremental Change
174
Therapist Improvisation: Shifting Domains of Operation
.1.74
Finding the Middle Ground
175
177
Guidelines for Subsystem Sessions
VII.
Guidelines for Seeing Parents or an Adolescent Alone
:177
Guidelines for SeeingParents and an Adolescent Together
.179
.
.
.
Multidimensional Family Therapy for Adolescent Cannabis Users
VIII. Appendixes
Appendix A. Key Terms and Abbreviations
181.
Organizing Terms
181
Theory-Related Terms
182
Clinically Related Terms
183
Appendix B. Administrative Issues in Implementing
MDFP in CYI'
187
Treatment,
187
Therapist Training, Supervision, and Protocol
Monitoring
-187
Roles of clinical coordinator and supervisor
-187
Supervision goals
-187.
Supervision schedule
-I 87
Cross-site standardization
-I 87
Therapist training
188
Quality Assurance of Treatment
-188
Certification.
:188
Treatment adherence
189
Written documentation
189
Chart review
189
Project Clinical Meetings
190
Common Treatment Issues
190
Missed sessions
190
Lateness
190
Participants showing up high
190
Threat of harm to oneself or others
190
Participants receiving collateral services
191
Abstinence
191
Dropped cases
191
Confidentiality
191
.Data Storage and Staff Access
191
Audiotape and Videotape Storage and Access
192
Participant ID Numbers
192
Crisis Procedures
192
Assessing Suicidality and Threat of Harm to Others
192
If the participant commits to safety
193
If the participant does not commit to safety
193
If a patient refuses inpatient admission
193
,Phone Crisis
193
If the participant commits to safety
193
If the participant does not commit to safety
193
If there is a threat of violence
:194
If the participant has contraband (e.g., weapons
and drugs)
194
Deciding on a Higher Level of Care
:194
Appendix C. Videotape Analysis Outline/Format
195
Activity Defined
:195
Goals of the Activity
:195
C`L1
Table of Contents
Appendix D. Summary of the mDFT Research Program
197
199
Randomized, Controlled Trials and Studies of MDFT
200
Summary
Appendix E. Clinical Management of a Mul.tisite Field Trial of Five
Outpatient Treatments for Adolescent Substance Abuse
207
227
IX. References
9