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Parallel Demand-Withdraw Interaction in Family Therapy for Adolescent Drug Users.

Psychology of Addictive Behaviors 2014;28(2):420-430. [doi: 10.1037/a0031812]

Kristina N. Rynes, PhD (University of New Mexico), Florencia Lebensohn-Chialvo, Michael J. Rohrbaugh, PhD, Varda Shoham, PhD (University of Arizona, WS Node).

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. (Article (Peer-Reviewed), PDF, English, 2013)

Keywords: Adolescents | Behavior therapy | Brief Strategic Family Therapy (BSFT) | CTN platform/ancillary study | Family therapy | Psychology of Addictive Behaviors (journal)

Document No: 960, PMID: 23438248, PMCID: PMC4021008.

Submitted by CTN Dissemination Librarians, 3/5/2013.

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