Brief Strategic Family Therapy Manual

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Therapists help adults learn to collaborate with one another to nurture, guide, and handle misbehavior among children and teens. He is professor of public health sciences, architecture, psychology, and educational and psychological studies at the University of Miami, and director of the Center for Family Studies at the University of Miami Miller School of Medicine. She has held academic positions at the University of Miami, Florida International University and Barry University. It describes a mature clinical model, a “love therapy,” that is one of the most well researched family therapy models at our disposal. The writers do an impressive job of describing this kind of family work in clear and easy to understand ways. The concepts are aptly illustrated with engaging and compelling case examples that illustrate the complexities of families and the challenging decision points of therapists who work to help them. The authors address in detail the “how to” parts of working with these families. I thoroughly enjoyed reading this book, and I learned a lot. I encourage readers to digest every word. Taken from description found at on May 2, 2014. These co-occurring problem behaviors include conduct problems at home and at school, oppositional behavior, delinquency, associating with antisocial peers, aggressive and violent behavior, and risky sexual behavior. BSFT is based on three basic principles: First, BSFT is a family systems approach. Second, patterns of interaction in the family influence the behavior of each family member. The role of the BSFT counselor is to identify the patterns of family interaction that are associated with the adolescent's behavior problems. Third, plan interventions that carefully target and provide practical ways to change those patterns of interaction that are directly linked to the adolescent's drug use and other problem behaviors. Condensed from description found at on May 2, 2014. Taken from description found at on May 2, 2014. http://thaiboxes.com/piceditor/brother-pe-200-embroidery-machine-manual.xml

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Journal of Substance Abuse Treatment, 23 (2), 123-132. Family Process, 45 (2), 259-271. The 10 articles chosen for BSFT are summarized below: Journal of Consulting and Clinical Psychology, 51, 889-899. Both developed within the conceptual framework of BSFT,Participants However, OPFT had Overall, both conditions were highly Hispanic), as well as small sample size. Journal of Consulting and Clinical Psychology, 54, 395-397. This study compares the relative effectiveness of two treatments based Both developed within the conceptual framework of BSFT,Participants Notable limitations of the study include the lack of a no-treatment Journal of Consulting and Clinical Psychology, 56 (4), 552. SSSE was developed within the conceptual This study tested the efficacy of the strategicTo assess the subject’s Another measure used was the Client-Oriented Data Acquisition Process (CODAP),Family Process, 40 (3), 313-332. The sample reported in this article was part of a large-scale, two-phase demonstration study testing the efficacy of BSFT with high-risk minority youth (first-phase: see above summary of Santisteban, Coatsworth, Perez-Vidal et al., 1997). 104 families were randomly assigned to BSFT or a community comparison (CC) condition selected to represent the common engagement and treatment practices of the community. The Revised Behavior Problem Checklist (RBPC), an empirically derived measure consisting of 89 problem behaviors, was administered. Results indicated that the families assigned to BSFT had significantly higher rates of engagement (81 vs. 61) and retention (71 vs. 42) than those assigned to CC. BSFT was also more effective than CC in retaining more severe cases, specifically cases with high levels of adolescent conduct disorder, and, despite the higher percentage of difficult-to-treat cases, achieved comparable treatment effects on behavior problems. A primary limitation of the study was that an intent-to-treat design was not able to be fully implemented. http://navigator-nsk.ru/userfiles/brother-pe-100-embroidery-machine-manual.xml

While the experimenters were able to complete termination assessment s for 77 of the families that participated in either treatment, limited resources restricted the ability to track and assess families that did not engage into treatment. Also, the study lacked post-intervention data, aside from the two data points of the pre-post design. Journal of Family Psychology, 17 (1), 121-133. Measures used include the Revised Behavior Problem Checklist (RBPC), which measures adolescent behavior problems; the Addiction Severity Index (ASI), which measures drug involvement; the Family Environment Scale (FES) and the Structural Family Systems Rating (SFSR), which both measure family functioning. Results showed that, compared to GC cases, BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self-reports of family functioning. On all three presenting problems targeted in this study (i.e., conduct problems, peer-based delinquency, and self-reported drug use), BSFT was significantly more efficacious than the GC. For example, in the BSFT condition, 41 who had been using at intake were no longer using at termination of treatment, compared to 13 in the GC condition. Limitations of the study include the lack of follow-up assessment s, that termination assessment s were conducted only with cases that completed treatment, and that a substantial proportion of treatment completers did not have complete observational data (participants’ entire families had to be present at both intake and termination assessment s for the participant to have complete observational data). Contemporary Clinical Trials, 30 (3), 269-278. http://www.drupalitalia.org/node/76819

Adolescents included in the study were those who used any illicit drug (other than alcohol and tobacco) in the 30-day period that preceded baseline assessment, or those referred to community agencies for the treatment of problems associated with drug use. This paper describes the following aspects of the study: specific aims, research design and study organization, assessment of primary and secondary outcomes, study treatments, data analysis plan, and data monitoring and safety reporting. The analyses and subsequent results have yet to be reported. Adolescents completed the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS), Youth Self-Report (YSR) of the Child Behavior Checklist, and Self-Report Delinquency Scale. Parents completed the Family Environmental Scale (FES) and Parenting Practices Questionnaire. Results indicated that Black families reported significantly lower externalizing and significantly higher family functioning than did Caucasian families regardless of reporter. Black adolescents also reported lower externalizing than Hispanic and Caucasian adolescents, and Black parents reported higher family functioning than Hispanic and Caucasian parents. The major study limitation was the possibility that Black youth with more severe symptoms may be systematically less likely to be given the opportunity to participate in research trials which may affect generalizability and statistical significance. Journal of Consulting and Clinical Psychology, 79 (6), 713-727. The primary outcome was adolescent drug use, assessed monthly via adolescent self-report and urinalysis for up to 1 year post randomization. Secondary outcomes included treatment engagement (?2 sessions), retention (?8 sessions), and participants’ reports of family functioning 4, 8, and 12 months following randomization. No overall differences between conditions were observed in the trajectories of self-reports of adolescent drug use. http://afhobiecat.com/images/bridgeport-vmc-800-manual.pdf

However, the median number of days of self-reported drug use was significantly higher in TAU then BSFT at the final observation point. BSFT was significantly more effective than TAU in engaging, and retaining family members in treatment and in improving parent reports of family functioning. Limitations include low rates in self-reported drug use at baseline and over the course of the study. Journal of Consulting and Clinical Psychology, 79 (1), 43-53. Measures utilized were the BSFT Therapist Adherence Form, the Clinical Supervision Checklist.The Brief Strategic Family Therapist treatment was compared to treatment as usual. Therapists were also randomly assigned to treatment condition within agencies. Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Results also showed that over time therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use. Limitations results can only be generalized to therapists from community agencies that participate in weekly group supervision. Sessions, measures included in this study were designed to tap various aspects of the BSFT intervention, and are specific to the BSFT model, and the measure may be limited in identifyingAddictive Behaviors, 42, 44-50. This paper uses data from the BSFT effectiveness study conducted in the National Drug Abuse Treatment Clinical Trials Network. Participants were randomized to BSFT or treatment as usual (TAU) across eight outpatient treatment programs community treatment programs (CTPs) across the country. Adolescent substance use was assessed at baseline and at 12 monthly follow-up assessment s. All additional adolescent and family assessment s were completed at baseline and 4-, 8-, and 12-months postrandomization. http://thanhlamresort.vn/wp-content/plugins/formcraft/file-upload/server/content/files/162878fd34b445---calculate-logarithm-manually.pdf

Parent alcohol and drug use were assessed at baseline and at 12 months postrandomization. Results found parents in BSFT significantly decreased their alcohol use as measured by the ASI composite score from baseline to 12 months. Change in family functioning mediated the relationship between treatment condition and change in parent alcohol use. Children of parents who reported drug use at baseline had three times as many days of reported substance use at baseline compared with children of parents who did not use or only used alcohol. Adolescents of parents who used drugs at baseline in the BSFT group had a significantly lower trajectory of substance use than adolescents in the TAU group. Limitations include the study only assessed parents at baseline and at 12 months postrandomization, only allowing a pre-post examination, high attrition rate, and TAU consisted of an array of services, including nonmanualized family therapy. Family Process, 45 (2), 259-271. Health and Human Services. Some key studies are abstracted below: The Efficacy of Brief Strategic Family Therapy in Modifying Hispanic Adolescent Behavior Problems and Substance Use. In this study the efficacy of BSFT in reducing adolescents' behavior problems, association with antisocial peers, marijuana use, and improving family functioning was investigated. Families were randomly assigned to either BSFT or group counseling. Conduct disorders were significantly reduced among adolescents in families receiving BSFT. Adolescents who entered treatment at clinical levels of association with antisocial peers were 2.5 times more likely to reliably improve than were adolescents in group treatment. Similarly, 60 of those adolescents reporting marijuana use at the beginning of treatment showed a reduction in drug use. Among families who began with poor family functioning, the results showed that those assigned to BSFT had a significant improvement in family functioning as measure by the Structural Family Systems Ratings. AYHANCEVIK.COM/images_upload/files/canon-speedlite-220ex-manual.pdf

Sources: Santisteban, D.A. et al. (2003). The efficacy of Brief Strategic Family Therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology 17(1): 121-13. Journal of Marital and Family Therapy 17(3): 295-310. Structural Family versus Psychodynamic Child Therapy for Problematic Hispanic Boys. Structural family therapy, psychodynamic child therapy, and a recreational control condition were compared for 69 six- to-twelve-year-old Hispanic boys who presented with behavioral and emotional problems. The results suggest that the control condition was significantly less effective in retaining cases than the two treatment conditions, which were apparently equivalent in reducing behavioral and emotional problems as well as in improving psychodynamic ratings of child functioning. Structural family therapy was more effective than psychodynamic child therapy in protecting the integrity of the family at 1-year follow-up. Finally, the results did not support basic assumptions of structural family systems therapy regarding the mechanisms mediating symptom reduction. Engaging Adolescent Drug Abusers and Their Families into Treatment: a strategic Structural Systems Approach. This article presents evidence for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy. To overcome resistance, the identified pattern of interactions that interferes with entry into treatment is restructured. Subjects were 108 Hispanic families in which an adolescent was suspected of, or was observed, using drugs. Subjects were randomly assigned to a strategic structural-systems engagement (experimental) condition or to an engagement-as-usual (control) condition. Subjects in the experimental condition were engaged at a rate of 93 compared with subjects in the control condition, who were engaged at a rate of 42. {-Variable.fc_1_url-

Seventy-seven percent of subjects in the experimental condition completed treatment compared with 25 of subjects in the control condition. In this study conducted in November of 2014, 480 adolescents and parents were randomized to BSFT or Treatment as Usual (TAU) across eight outpatient treatment programs.Parent substance use was assessed at baseline and at 12 months’ post-randomization. Adolescent substance use was assessed at baseline and monthly for 12 months’ post-randomization. Family functioning was assessed at baseline, 4, 8, and 12 months’ post-randomization.Parents in BSFT significantly decreased their alcohol use from baseline to 12 months. Change in family functioning mediated the relationship between Treatment Condition and change in parent alcohol use. Adolescents in BSFT had a significantly lower trajectory of substance use than those in TAU if their parents used drugs at baseline. Conclusions - BSFT is effective in reducing alcohol use in parents, and in reducing adolescents' substance use in families where parents were using drugs at baseline. BSFT may also decrease alcohol use among parents by improving family functioning. Additionally, it seems to be particularly beneficial for teens of parents who were using drugs at baseline, information useful in targeting adolescents who can best benefit from this intervention. Addictive Behaviors, Vol. 42 (pages 44-50) Bullying Girls- Changes after Brief Strategic Family Therapy: A Randomized, Prospective,Controlled Trial with One-Year Follow-Up (2006) Our aim was to determine the efficacy of brief strategic family therapy (BSFT) for bullying-related behavior, anger reduction, improvement of interpersonal relationships, and improvement of health-related quality of life in girls who bully, and to find out whether their expressive aggression correlates with their distinctive psychological features. https://www.orhancoskun.com/wp-content/plugins/formcraft/file-upload/server/content/files/162878ff7e19ef---Calculate-h-index-manually.pdf

Methods: 40 bullying girls were recruited from the general population: 20 were randomly selected for 3 months of BSFT. Follow-up took place 12 months after the therapy had ended. The results of treatment were examined using the Adolescents’ Risk-taking Behavior Scale (ARBS), the State-Trait Anger Expression Inventory (STAXI), the Inventory of Interpersonal Problems (IIP-D), and the SF-36 Health Survey (SF-36). Results: In comparison with the control group (CG), bullying behavior in the BSFT group was reduced and statistically significant changes in all risk-taking behaviors (ARBS), on most STAXI, IIP-D, and SF-36 scales were observed after BSFT. The reduction in expressive aggression (Anger-Out scale of the STAXI) correlated with the reduction on several scales of the ARBS, IIP-D, and SF-36. Follow-up a year later showed relatively stable events. Conclusions: Our findings suggest that bullying girls suffer from psychological and social problems which may be reduced by the use of BSFT. The other 36 boys formed the control group. After 12 weeks' treatment, we observed a significant reduction in bullying behaviour in the BSFT group and in the mean values for salivary cortisol concentration. The BSFT group also showed significantly greater change on the STAXI subscales State-Anger, Trait-Anger, Anger-Out, and Anger-Control. Treatment with BSFT also resulted in significant improvement on the SF-36 subscales for Vitality, Social Functioning, Role-Emotional, and Mental Health. Conclusion: BSFT effectively influenced bullying behaviour, salivary cortisol concentration, anger, and health-related QoL in adolescent bullying boys. Source: Marius K Nickel, MD, Moritz Muehlbacher, MD, Patrick Kaplan, MD, Jakub Krawczyk, MD, WiebkeBuschmann, MD, Christian Kettler, MD, Nadine Rother, Christoph Egger, MD, Wolfhardt K Rother, MD, Thomas K Loew, MD, Cerstin Nickel, MD. Washington D.C.: American Psychological Association Press. Szapocznik, J., Hervis, O. (2003). AYBAR-GALLERY.COM/userfiles/files/canon-speedlite-220ex-flash-manual.pdf

Therapy manuals for drug addiction. Manual 5, Brief strategic family therapy for adolescent drug abuse. Washington, D.C.: Pan American Health Organization. Amsterdam, The Netherlands: Swets and Zeitlinger. Miami, FL: Spanish Family Guidance Center, Department of Psychiatry, University of Miami School of Medicine. New York: Springer Publishing Company. Robbins, M., Hervis, O.E., Mitrani, V., and Szapocznik, J., (2000) Assessing Changes in Family Interactions: The Structural Family Systems Ratings. In P.K.Kerig and K.M. Lindahl, Family Observational Coding Systems, New Jersey: Lawrence Erlbaum Associates. Hispanic Journal of Behavioral Sciences, 12 (2), 177-195. Santisteban, D. A., et al, (2003), “The Efficacy of Brief Strategic Family Therapy in Modifying Hispanic Adolescent Behavior Problems and Substance Use” Journal of Family Psychology Mar;17(1):121-33. Abstract Despite the efficacy of family-based interventions for improving outcomes for adolescent behavior problems such as substance use, engaging and retaining whole families in treatment is one of the greatest challenges therapists confront. Research evidence for efficacy and effectiveness is also presented. INTRODUCTION The Johnson family includes 15 year-old Andrew, his mother Mrs. Johnson, stepfather Mr. Johnson, and 13 year old son Jordan, and mother and step-father’s 5 year old son, Malik. Andrew was referred for treatment by the Probation Officer assigned to his case after his recent release from an inpatient locked treatment facility for sexual offenders where he was receiving treatment following a sexual incident involving two neighborhood boys three and four years younger than him. Andrew had been using alcohol and drugs at the time of the incident. Mr. and Mrs. Johnson struggled with their son’s incarceration and consequently only visited him twice during his 16 month stay. Mrs. Johnson reported that upon returning home, Andrew has been increasingly distant from his family; he now consistently isolates himself from others. Andrew is also increasingly in conflict with his parents, is performing poorly in school, and has been using marijuana. Mrs. Johnson worries that Andrew will fall-in with the wrong crowd of peers, and continue a dangerous path toward drug use and delinquency. Mr. and Mrs. Johnson both would like to help Andrew but often appear at odds with each other on how to accomplish this goal. Although the focus of the BSFT model is to address drug use and related behavior problems of the adolescent, therapists accomplish this by working relationally with the entire family. Family relations therefore, represent the targets for change in concert with the individual problems associated with these maladaptive family relations. Specifically, the BSFT model aims to strengthen adaptive family interactions, such as the concerns of Mr. and Mrs. Johnson for Andrew; and correct maladaptive patterns of family interactions, such as Mr. and Mrs. Johnson being at odds with how to approach Andrew’s problems that could be unwittingly supporting Andrew’s isolation, alienation from the family, and drug use. As discussed below, the role of social systems is a central tenet of both the BSFT approach and social work. Clinical social workers will find the BSFT approach to be consistent with their systems training and clinical practice. The BSFT model offers concepts that can be useful to the social worker in practice such as the emphasis on repetitive patterns of family interactions. When multiproblem families present for services, the therapist can become overwhelmed by the many urgent issues confronting (and overwhelming) these families. Attention to repetitive patterns of interactions among family members allows the therapist to attend to family systemic processes common across the many problems confronting a family, without getting lost in the multiplicity of urgent contents. The BSFT model also provides social workers with a set of intervention tools to engage families in treatment, become an accepted member of the family system so that interventions are more easily accepted by the family, tools to create a motivational context for change, and finally tools to change the maladaptive patterns of interactions that do not allow families to achieve their own goals. Brief Strategic Family Therapy (BSFT) is a family-based, empirically validated intervention designed to treat children's and adolescents' problem behaviors such as those presented by Andrew in our case example. To produce behavior change, BSFT therapists work to increase motivation for behavior change, reduce concerns about change, identify adaptive interactions and strengthen them, and identify troubled family interactions and modify them. One of the most important innovations of the BSFT approach has been the belief that challenges in engaging families into treatment are derived from the same interactional problems maintaining the adolescent’s problem behaviors. In the Johnson case for example, Mr. and Mrs. Johnson were often incongruent in their parenting beliefs, preventing them from taking a unified, collaborative stance in supporting Andrew. Their discrepant parenting opinions similarly represented an obstacle to entering treatment. The same intervention techniques, namely joining, tracking and diagnostic enactment, and reframing therefore, were utilized to engage the family into therapy. In this paper we describe how the principles and techniques used in the BSFT approach can be applied by social workers to engaging family members for treatment and provide a detailed case example of how this approach looks in practice. We also provide evidence for the efficacy and effectiveness of BSFT engagement strategies and briefly discuss potential policy implications. As suggested by Bronfenbrenner (1986), we perceive the family as the principal force shaping the way a child thinks, feels and behaves. The BSFT approach asserts, therefore, that family relations - as the child’s most proximal social-ecological context - play a central role in the development and maintenance of behavior problems including drug abuse, and consequently represent a primary target for intervention. The BSFT approach recognizes that although the family is the primary context of human development, the family itself is also part of a larger social system and, like an adolescent is influenced by his or her family, the family is influenced by the larger social system in which it exists ( Bronfenbrenner, 1979 ). For instance, the Johnson family resided in a relatively close, tight-knit community in which many community members knew about their son Andrew’s recent difficulties. Their shame, combined with their desire to not draw attention to his incarceration, influenced Andrew’s presenting symptom of isolation. The BSFT therapist in this case, recognized this sensitivity to contextual factors that created on the one hand risk through peers of substance abuse, and on the other the family’s shame toward its community that was manifested in Andrew’s isolation. System The first construct central to the BSFT approach is a systems approach. Systems and eco-systemic perspectives have long been central to social work theory and practice ( Wakefield, 1996 ). It is not surprising then, that in the authors’ experience, social workers readily learn BSFT. A system is an organized whole comprised of separate interrelated and interdependent parts. A family, for example, is a system comprised of individuals whose behaviors and interactional patterns inherently affect each other. The BSFT model is based on the principle that family members are interdependent: The experiences and behavior of each individual family member affect the experiences and behavior of all other family members. The adolescent’s behavior therefore, is believed to reflect larger maladaptive family interactions. The case of the Johnson family, as we will explain, represents an example of how the son Andrew’s problem behaviors, particularly his isolation and involvement in drugs, co-occurred with maladaptive interactional patterns that prevented the family from adequately achieving their goal of changing Andrew’s conduct. Structure The second construct fundamental to the BSFT approach is structure. The set of repetitive patterns of interactions within the family system is called the family's structure. A maladaptive family structure is characterized by repetitive family interactions in which family members repeatedly elicit the same unsatisfactory and potentially harmful responses from other family members. In our case example, Mr. and Mrs. Johnson’s inability to effectively collaborate on parenting functions interfered with their goals of changing Andrew’s behaviors. In particular, when the conflict between the parents was around Andrew’s behavior, often the parent in frustration with each other lashed out at Andrew, causing him to withdraw and pull away from the family. Strategy The third essential concept of the BSFT approach is strategy, characterized by using interventions that are practical, problem-focused, and deliberate. Practical interventions are selected for their likelihood to move the family toward desired objectives. The overarching goal of BSFT strategy is to target the repetitive maladaptive patterns of family interactions while strengthening adaptive patterns of interaction that will achieve the caregivers’ goal of reducing the adolescent’s problematic and risky behavior. As a problem-focused approach, the BSFT model targets family interaction patterns that are directly relevant to the youth's symptoms. As we will see in the Johnson family, addressing the conflict between the two parents was essential to avoid their taking their frustration out on Andrew. Interventions simultaneously attempted to reduce the attacking and blaming among the parents, allow for more positive communication that led to collaborative parenting behaviors that could effectively improve the issues that so much concerned them in Andrew’s behaviors, isolation, poor school functioning and drug use. Also, of course, confronting the shame that prevented them from talking with Andrew about the sexual incident that send him to jail, was essential to avoid a similar incident re-occurring. BSFT intervention strategies are very deliberate, meaning that the therapist identifies the maladaptive interactions that if changed are most likely to lead to the desired outcomes (i.e., adolescent prosocial behavior). For instance, before working on Andrew’s behavior management, the BSFT therapist has to focus on reestablishing the positive emotional connection between Andrew and his parents so that their attempt to address his behavior can be viewed as an expression of concern and love for him and will be less likely to be rejected. As Figure 1 indicates, though there is a general sequence to their use, the sequence is used continuously during the intervention, and early interventions such as joining are often used frequently throughout the treatment process. Open in a separate window Figure 1 BSFT Circular Theory of Change Joining is the process by which the therapist moves from being an outsider to becoming a member of the therapeutic team that includes the therapist and the family.