Brief Strategic Family Therapy

Program Goals and Target Population

Brief Strategic Family Therapy (BSFT) is a family-based intervention designed to prevent and treat child and adolescent behavior problems. The goal of BSFT is to improve a youth’s behavior by improving family interactions that are presumed to be directly related to the child’s symptoms, thus reducing risk factors and strengthening protective factors for adolescent drug abuse and other conduct problems. BSFT targets children and adolescents who are displaying—or are at risk for developing—behavior problems, including substance abuse.



Program Components

BSFT is based on the fundamental assumption that adaptive family interactions can play a pivotal role in protecting children from negative influences and that maladaptive family interactions can contribute to the evolution of behavior problems and consequently are a primary target for intervention. The therapy is tailored to target the particular problem interactions and behaviors in each client family. Therapists seek to change maladaptive family interaction patterns by coaching family interactions as they occur in session to create the opportunity for new, more functional interactions to emerge.



Major techniques used are joining (engaging and entering the family system), tracking and diagnosing (identifying maladaptive interactions and family strengths), and restructuring (transforming maladaptive interactions). Through the technique of joining, the therapist develops a therapeutic alliance with the family, one that gives due respect to each individual within the family as well as to the way the family is organized. As this working alliance is established, the therapist tracks and diagnoses family strengths, weaknesses, and patterns, which sets the foundation for the treatment plan. Restructuring or reframing techniques help the family reduce problematic relations and patterns, and instead develop mutually supportive and effective relations and patterns. Depending on the case, these techniques may include helping families develop effective behavior management skills, conflict resolution skills, or communications skills and helping parents learn parenting skills.



BSFT is a short-term, problem-oriented intervention. A typical session lasts 60 to 90 minutes and is held with the adolescent and one or more other family members. The average length of treatment is 12 to 16 sessions over a 3- to 4-month period. For more severe cases, such as substance-abusing adolescents, the average number of sessions and length of treatment may be doubled. Treatment can take place in the office, home, or community settings.

Intervention ID
245
Ages

12 to 18

Rating
Promising
Outcomes

The three evaluations of Brief Strategic Family Therapy (BSFT) produced inconsistent findings. Study 1 largely demonstrated no effects on adolescent drug use or family functioning, although the program had some positive effects on engagement and retention. Study 2 showed positive effects of the program on engagement and retention. Study 3 demonstrated promising reductions in behavior problems and some drug use behavior, as well as increases in family functioning. While the preponderance of evidence suggests promising outcomes, there were inconsistent findings, which should be considered prior to implementation.



Study 1

Adolescent Drug Use


Robbins and colleagues (2011) found that there were no overall significant differences of treatment on the trajectories of adolescent self-reported drug use. The median number of self-reported drug use days was significantly higher in the treatment as usual (TAU) condition than in the Brief Strategic Family Therapy (BSFT) condition at 12 months, but there were no significant differences at any other assessment time points.



Family Functioning

According to parent reports, BSFT was significantly more effective (although with a small effect) than TAU at improving family functioning. According to adolescent reports, however, there were no statistically significant differences between the treatment and control conditions in improvements in family functioning.



Engagement and Retention

Compared with TAU participants, BSFT participants had lower rates of failure to engage and failure to retain in treatment. BSFT treatment was 0.43 times as likely as TAU to fail to engage a participant into therapy and 0.71 as times as likely to fail to retain participants in therapy for at least eight sessions. BSFT had 48.6 percent of cases with unplanned termination, compared with 70.2 percent of TAU cases. BSFT condition also had significantly higher levels of attendance.



Study 2

Engagement and Retention


Coatsworth and colleagues (2001) found that BSFT was able to engage and retain a significantly larger number of cases than other forms of treatment. Families in the treatment group were more likely to engage in treatment (81percent versus 61 percent) and once engaged were more likely to stay in treatment to completion (71 percent versus 42 percent). Families in BSFT were 2.3 times as likely to engage and complete treatment as families in the comparison group. Researchers also found that BSFT was more successful at retaining cases with high levels of conduct disorder. Despite the higher percentage of difficult-to- treat cases, BSFT achieved comparable, if not slightly better, treatment effects on behavior problems than the comparison condition.



Study 3

Behavior Problems


Santisteban and colleagues (2003) found that BSFT participants showed significantly greater reductions in behavior problems at termination than did adolescents in the comparison condition. Participants in the BSFT group showed clinically significant improvement for both conduct disorder and socialized aggression.



Substance Use

Compared with the group treatment control (GC), participants in the BSFT group demonstrated a statistically significant reduction in marijuana use, but not in alcohol use.



Family Functioning

According to assessments with the Structural Family Systems Rating, families who demonstrated initial lower family functioning pretreatment showed significant improvement after participating in the BSFT group. Families with initial higher family functioning showed no improvements in functioning after BSFT treatment, but families in the GC showed statistically significant deterioration.



According to assessments using the Family Environment Scale, adolescent-reported cohesion showed a significant increase after BSFT treatment, but not within the GC condition in families in the worse family cohesion group.

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