Multidimensional Family Therapy, MDFT, is one of a new generation of empirically validated treatments for teen drug and behavior problems. I developed this family-based treatment 25 years ago with an ANIDA-funded clinical research project. MDFT is a comprehensive intervention.
It attends to diverse but interconnected aspects of the adolescent's current life. Putting the pieces of this puzzle together helps us to understand how drug-taking continues, but most important, it reveals what we can do to stop the slide of substance abuse. We take a broad-based approach, mobilizing multiple systems and sources of influence to help the adolescent and the family get back on track.
At the same time, we're precise in targeting our interventions. For instance, we know that... getting treatment off to a good start is essential and the key to a successful launch is a therapist's ability to create multiple therapeutic alliances with the teen, parent, and influential others such as school or juvenile justice personnel. MDFT is integrative. It combines elements from psychotherapy, family therapy, and drug counseling.
Research indicates MDFT is a consumer-friendly approach. Therapists, parents, teenagers, and collaborating professionals, including teachers, lawyers, and judges, understand and accept the approach rather quickly. They appreciate its intuitive and logical organization.
They respond to its emphasis on positive relationships, emotional connections, and its practical results-oriented philosophy. MDFT is not a one-size-fits-all model. It's a flexible treatment system that's used in a variety of clinical settings and with various adolescent populations. For example, MDFT has been adapted successfully for teens in juvenile detention, aftercare programs, drug courts, non-research community practice settings, and as an outpatient alternative to residential treatment.
Clinician functioning is inextricably linked to the success of this and all evidence-based practices. Manual guided interventions are ineffective in the hands of unskilled, unmotivated, or poorly functioning therapists. This DVD and the manual give an overview of the approach.
The manual also includes additional resource information. We've tested the MDFT approach in federally funded studies since 1985. Considerable published evidence has been found to be effective in evidence supports this treatment's effectiveness for adolescent substance abuse and delinquency. In 2009, we will complete our 10th MDFT control trial. When compared to a range of other manual guided treatments, including individual cognitive behavioral therapy, group counseling, multifamily groups, and residential treatment, MDFT demonstrates superior clinical outcomes. It's been evaluated with male and female adolescents from ages 11 to 18. from diverse cultural and ethnic backgrounds, geographic locales, and clinical conditions, including co-occurring disorders.
MDFT evidences consistently favorable outcomes on a variety of outcome indices across all of these trials. What are the main findings from these studies? MDFT effectively engages and retains diverse adolescents in treatment. 95% of clients in intensive outpatient MDFT stayed in treatment for 90 or more days, compared to 59% in a comparison residential treatment. In the same study, the six-month retention and treatment completion rates were 88% for the MDFT cases, compared to 24% of the residential treatment cases.
In another study, 96% of MDFT adolescents completed the four-month treatment compared to 78% of the group therapy kids. Substance abuse findings. Substance abuse was significantly reduced between 41 and 66 percent from intake to completion in two sample studies and these gains were maintained at one year follow-up.
Youth treated with MDFT often abstain from drug use and these change were stable post-discharge. For instance, in two different studies, 64% and 93% of adolescents reported abstinence from alcohol and drug use at one year follow-up. MDFT teens reduced the severity of their substance related problems at one year follow-up.
93% of MDFT youth reported no substance related problems. Adolescents reduced their delinquent behavior and affiliation with delinquent peers significantly more than those teens in peer group counseling and residential treatment. MDFT clients were less likely to be arrested or placed on probation than group clients.
And in a dissemination study, MDFT youth received significantly fewer out-of-home placements than teens treated by therapists prior to MDFT training. School functioning outcomes. MDFT clients showed a significantly greater decrease in disruptive school behaviors, absences, and significantly greater increases in grades and behavior than teens receiving comparison treatment.
family functioning and interaction. MDFT decreased family conflict, improved parenting practices, and improved family functioning to a greater degree than multifamily groups or peer group therapy. MDFT reduced risk of HIV, STD, and high-risk sexual behavior. MDFT significantly decreases unprotected sex acts and STDs.
D incidence more than existing services. MDFT is a cost-effective intervention. In one study, average weekly costs of treatment are significantly less for MDFT. At $164 a week, MDFT treatment was less than half the weekly cost for community-based outpatient treatment.
And another study showed that when compared with standard outpatient and residential treatment programs, MDFT offers superior clinical outcomes at one-third of the cost of residential treatment. MDFT process studies show improved parenting skills during therapy, changes in parents reduce teen symptoms, and addressing cultural themes increase teen treatment participation. The evidence is clear that MDFT is cost-effective and provides better outcomes than standard treatment modalities.
So what are the guiding principles of MDFT? There are ten guiding principles for MDFT. One, adolescent drug abuse is a multidimensional phenomenon.
Two, problem situations provide information and opportunity. Three, change is multidetermined and multifaceted. Four, motivation is malleable. Five, working relationships are critical. Six, interventions are individualized.
and foster developmental competence. Seven, planning and flexibility are two sides of the same therapeutic coin. Eight, treatment is phasic and continuity is stressed. Nine, the therapist's responsibility is emphasized.
Ten, the therapist's attitude is fundamental to success. Let's explain these principles in more detail. One, adolescent drug abuse is a multidimensional phenomenon.
Individual biological, social, cognitive, personality aspects, interpersonal or transactional aspects, familial, developmental, and social-ecological aspects all figure into an explanation for drug problems. Teen drug problems are understood in developmental and ecological terms. Therapists think in terms of the interaction of multiple systems and levels of influence.
Two, problem situations provide information and opportunity. Symptoms and problem situations of any kind provide assessment information as well as essential intervention opportunities. Three, change is multi-determined and multi-faceted.
Change emerges from interaction among systems and levels of systems, people, domains of functioning, and intrapersonal and interpersonal processes. A multivariate conception of change commits the clinician to a coordinated and sequential working of multiple change pathways and methods. Four, motivation is malleable. Motivation to enter treatment or to change will not always be present with adolescents or their parents. Treatment receptivity and motivation vary in individual family members and relevant extra-familial others.
Don't pathologize treatment reluctance. One of a therapist's most important tasks involves motivating teens and family members about treatment and change. Five, working relationships are critical.
Multiple therapeutic alliances come with the territory of family-based treatment. Therapists create individual alliances with the adolescent, the subsystem of individual parent or caregiver, and individuals outside of the family. who are involved with the youth.