Demand-withdraw interaction in family therapy for adolescent drug users.

Demand-withdraw interaction, a problematic pattern in which one person demands a change from another who resists or withdraws, occurs in both marital and parent-child dyads. In the treatment domain, intriguing evidence of a parallel demand-withdraw process comes from a study of couple therapy for alcohol men, where a wife-demand/husband-withdraw pattern predicted poor response to a high-demand therapeutic intervention. This study, an ancillary investigation of data from protocol CTN-0014, “Brief Strategic Family Therapy (BSFT) for Adolescent Drug Abusers,” extends this parallel-process idea to family therapy for adolescent drug users. Researchers hypothesized that adolescents entrenched in parent-demand/adolescent-withdraw (PD/AW) interaction before treatment began would show poorer substance use outcomes if they engaged in parallel therapist-demand/adolescent-withdraw interaction during family therapy. Results suggest that attending to these parallel demand-withdraw processes (parent/adolescent and therapist/adolescent) may be useful in clinical work with families of substance-using adolescents. In particular, an inadvertent replication of ineffective parent behavior within the therapeutic system may undermine the prospect of positive youth outcomes. Case conceptualization and treatment planning for families exhibiting high levels of PD/AW interaction may benefit from consideration of how the therapist can best maintain balanced alliances and avoid a high-demand stance toward the target adolescent.

Related protocols: CTN-0014-A-1