Parallel demand-withdraw processes in family therapy for adolescent drug abuse.
This is the Results Article for CTN-0014-A-1.
Isomorphism, or parallel process, occurs in family therapy when patterns of therapist-client interaction replicate problematic interaction patterns within the family. This study investigated parallel demand-withdraw process in Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, hypothesizing that therapist-demand/adolescent-withdraw interaction (TD/AW) cycles observed early in treatment would predict poor adolescent outcomes at follow-up for families who exhibited entrenched parent-demand/adolescent-withdraw interaction (PD/AW) before treatment began.
Participants were 91 families who received at least four sessions of BSFT in the National Drug Abuse Treatment Clinical Trials Network (CTN) study CTN-0014 (“Brief Strategic Family Therapy (BSFT) for Adolescent Drug Abusers”), a multisite clinical trial on adolescent drug abuse. Prior to receiving therapy, families completed videotaped family interaction tasks from which trained observers coded PD/AW. Another team of raters coded TD/AW during two early BSFT sessions. The main dependent variable was the number of drug-use days that adolescents reported in timeline follow-back interviews 7 to 12 months after family therapy began. Zero-inflated Poisson regression analyses supported the main hypothesis, showing that PD/AW and TD/AW interacted to predict adolescent drug use at follow-up. For adolescents in high PD/AW families, higher levels of TD/AW predicted significant increases in drug use at follow-up, whereas for low PD/AW families, TD/AW and follow-up drug use were unrelated.
Conclusions: Results suggest that attending to parallel demand–withdraw processes in parent–adolescent and therapist–adolescent dyads may be useful in family therapy for substance-using adolescents, as it appears that parallel demand-withdraw processes in family therapy for adolescent drug abuse can compromise treatment outcome. Findings highlight two key BSFT principles — remaining decentralized and placing more demand for change on parents than on adolescents — and suggest these principles are particularly important to observe with therapists work with families that exhibit PD/AW.
Related protocols: CTN-0014-A-1