Therapist adherence in Brief Strategic Family Therapy for adolescent drug abusers.

Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this ancillary study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents receiving Brief Strategic Family Therapy as part of protocol CTN-0014, “Brief Strategic Family Therapy (BSFT) for Adolescent Drug Abusers.” 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.

Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use. Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy. Although this measure was developed specifically for the BSFT intervention, it is possible that the domains identified may be present in other empirically based family interventions and, as such, future studies may consider validating the use of this or similar measures with other clinical models and populations. The results of this study provide a necessary first step by validating a measure that can be used to capture the complexity of family therapy, and can be used to understand mechanisms of change in family therapy with drug-using youth.

Related protocols: CTN-0014