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1. Brief Strategic Family Therapy (BSFT)

Developers:
Szapocznik, Jose, Hervis, Olga, Schwartz, Seth. (University of Miami School of Medicine, Department of Psychiatry and Behavioral Sciences; Center for Family Studies)

Summary:
Brief Strategic Family Therapy (BSFT) is a brief intervention used to treat adolescent drug use that occurs with other problem behaviors. 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 targets family interactions that are thought to maintain or exacerbate adolescent drug abuse and other behavioral problems. BSFT typically involves 12 to 24 sessions, lasting about 90 minutes, for 4 months, plus up to 8 "booster" sessions. The number of sessions needed depends on the severity of the problem.

BSFT is based on three basic principles. The first is that BSFT is a family systems approach. Family systems means that family members are interdependent: What affects one family member affects other family members. According to family systems theory, the drug-using adolescent is a family member who displays symptoms, including drug use and related co-occurring problem behaviors. The second BSFT principle is that the patterns of interaction in the family influence the behavior of each family member. The third principle of BSFT is to plan interventions that carefully target and provide practical ways to change those patterns of interaction

Sessions may be conducted in the office or at the family’s home, and an attempt is made to include the entire family in treatment, with a special emphasis on engaging reluctant family members.

One of BSFT's strengths is its considerable flexibility, which makes it extremely adaptable to a broad range of family and youth situations and problems. The disadvantage of BSFT is that it is not a simple-to follow recipe (a pinch of empathy and an ounce of joining). Rather, BSFT is an advanced clinical model that requires the counselors who use it to have considerable skill. BSFT appeals to cultural groups that emphasize family and interpersonal relationships.

The goal of BSFT is to eliminate or reduce the adolescent's use of drugs and associated problem behaviors, known as "symptom focus," and to change the family interactions that are associated with the adolescent's drug abuse, known as "system focus." Family preservation is also desirable whenever possible.

This intervention was studied in NIDA's National Drug Abuse Treatment Clinical Trials Network, in a large, multi-site investigation of BSFT compared to treatment as usual. While the study found BSFT had weak effects on drug use outcomes, it had a much stronger impact on engagement, retention, and parent-reported family functioning with adolescents from diverse racial/ethnic groups than treatment as usual. For more information, see: http://www.nida.nih.gov/CTN/ctn_0014.html

Brief Strategic Family Therapy for Adolescent Drug Abuse.

Szapocznik J, Hervis O, Schwartz S. NIDA Therapy Manuals for Drug Abuse no. 5, NIH Publication Number 03-4751. Rockville, MD : National Institute on Drug Abuse, 2003.

Download manual: http://ctndisseminationlibrary.org/display/32.htm

Intervention Details:

Population studied:Adolescents; Hispanics; Adults
Drug studied:Applicable to most drug problems
Therapy format:Family
Therapy type:Behavioral; Brief intervention
Setting:Outpatient

Training/Technical Assistance: Information about training for BSFT is available on the Center for Family Studies web site: http://www.cfs.med.miami.edu/Docs/ClinicalApproach.htm, and also from the Family Therapy Institute of Miami (FTTIM), http://www.brief-strategic-family-therapy.com/bsft.

Noteworthy:

  • Selected as a NIDA therapy manual
  • Selected as a SAMHSA Model Program

Supporting References:

  1. Robbins MS et al. Brief Strategic Family Therapy versus Treatment as Usual: Results of a Multisite Randomized Trial for Substance Using Adolescents. Journal of Consulting and Clinical Psychology 2011;79(6):713-727.
  2. Santisteban DA, Szapocznik J, Perez-Vidal A, Kurtines W, Murray EJ, Laperriere A. Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology 1996; 10:35 – 44.
  3. Szapocznik J, Perez-Vidal A, Brickman AL, Foote FH, Santisteban D, Hervis O, Kurtines WM. Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Consulting and Clinical Psychology 1988;56:552–557.
  4. Szapocznik J, Kurtines WM, Foote F, Perez-Vidal A, Hervis O. Conjoint versus one-person family therapy: Some evidence for effectiveness of conducting family therapy through one person. Journal of Consulting and Clinical Psychology 1986;54: 395-397.
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