Brief Strategic Family Therapy

Ages:	6 - 17
Rating:	Level 2

Intervention:

Brief Strategic Family Therapy (BSFT) is a family-based intervention designed to prevent and treat child and adolescent behavior problems. BSFT targets children and adolescents who are displaying—or are at risk for developing—behavior problems, including substance abuse. BSFT is based on the fundamental assumption that adaptive family interactions can play a pivotal role in protecting children from negative influences and that maladaptive family interactions can contribute to the evolution of behavior problems and consequently are a primary target for intervention. The goal of BSFT is to improve a youth’s behavior problems by improving family interactions that are presumed to be directly related to the child’s symptoms, thus reducing risk factors and strengthening protective factors for adolescent drug abuse and other conduct problems. The therapy is tailored to target the particular problem interactions and behaviors in each client family. Therapists seek to change maladaptive family interaction patterns by coaching family interactions as they occur in session to create the opportunity for new, more functional interactions to emerge. Major techniques used are joining (engaging and entering the family system), diagnosing (identifying maladaptive interactions and family strengths), and restructuring (transforming maladaptive interactions). BSFT is a short-term, problem-oriented intervention. A typical session lasts 60 to 90 minutes. The average length of treatment is 12 to 15 sessions over more than 3 months. For more severe cases, such as substance-abusing adolescents, the average number of sessions and length of treatment may be doubled. Treatment can take place in office, home, or community settings.

Evaluation:

Numerous studies have looked at the effectiveness of BSFT. The most comprehensive study used an experimental pretest–posttest design with 104 families of African-American (n=25) or Hispanic (n=79) descent. Families were eligible for the study if they had a of 12- to 14-year-old child about whom the family or school reported a complaint of externalizing problems in the form of misconduct, internalizing problems in the form of anxiety/depression, had significant academic problems, or had initiated drug or alcohol use. Adolescents who had attempted suicide were not excluded form the study. The sample was 75 percent male, with a mean age of 13.1. Participants were randomized to the experimental condition or the community comparison condition. The two groups were not significantly different. The experimental group received BSFT, while the comparison group received whatever therapy the particular community agency used. Researchers assessed the adolescents’ behavior problems as well as engagement and retention in treatment.

Outcome:

The evaluation found positive results similar to other evaluations. BSFT was able to engage and retain a significantly larger number of cases than other forms of treatment. Families in the treatment group were more likely to engage in treatment (81percent versus 61 percent) and once engaged were more likely to stay in treatment to completion (71 percent versus 42 percent). Families in BSFT were 2.3 times as likely to engage and complete treatment than families in the comparison group. Researchers also found that BSFT was more successful at retaining cases with high levels of conduct disorder. Despite the higher percentage of difficult-to- treat cases, BSFT achieved comparable, if not slightly better, treatment effects on behavior problems than the comparison condition.

Past research has also shown improvements in self-concept and family functioning, as well as reductions in substance abuse, conduct problems, emotional problems, and associations with antisocial peers.

Risk Factor:

Family

• Family management problems / Poor parental supervision and/or monitoring

• Pattern of high family conflict

• Poor family attachment / Bonding

• Sibling antisocial behavior

Individual

• Antisocial behavior and alienation / Delinquent beliefs / General delinquency involvement / Drug dealing

• Favorable attitudes toward drug use/Early onset of AOD use/Alcohol and/or drug use

• Early onset of aggression and/or violence

Protective Factor:

Family

• Effective parenting

• Good relationship with parents / Bonding or attachment to family

• Having a stable family

Individual

• Social competencies and problem solving skills

• Self-efficacy

• Perception of social support from adults and peers

References:

Coatsworth, J.D., Santisteban, D.A., McBride, C., Szapocznik, J. (2001). "Brief Strategic Family Therapy Versus Community Control: Engagement, Retention, and an Exploration of the Moderating Role of Adolescent Symptom Severity." Family Process, 40: 313-332.

Hervis, O.E., Shea, K.S.,& Kaminsky, S.M. 2009. "Brief Strategic Family Therapy: Treating the Hispanic Couple Subsystem in the Context of Family, Ecology and Acculturative Stress." In Thomas, V.K. & Rastogi, M. (Eds) Multicultural Couples Therapy, California: Sage Publications.

Nickel, M., et al. (2006). "Bullying Girls – Changes After Brief Strategic Family Therapy: A Randomized, Prospective, Controlled Trial with One-Year Follow-Up." Psychotherapy and Psychosomatics, 75: 47-55.

Nickel, M. et al. (2006). "Influence of Family Therapy on Bullying Behaviour, Cortisol Secretion, Anger, and Quality of Life in Bullying Male Adolescents: A Randomized, Prospective, Controlled Study." Canadian Journal of Psychiatry, 51: 355-362.

Robbins, M.S., & Szapocznik, J. (2000). "Brief Structural Family Therapy with Behavior Problem Youth." Office of Juvenile Justice and Delinquency Prevention Bulletin. Office of Justice Programs, U.S. Department of Justice, Washington, D.C.

Santisteban, D.A., Coatsworth, J.D., Perez Vidal, A., Kurtines, W.M., Schwartz, S.J., LaPerriere, A., & Szapocznik, J. (2003). "The Efficacy of Brief Strategic Family Therapy in Modifying Hispanic Adolescent Behavior Problems and Substance Use." Journal of Family Psychology, 17(1): 121-133.

Santisteban, D.A., Szapocznik, J., Perez-Vidal, A., Kurtines, W.M., Murray, E.J., & Lapierre, A. (1996). Efficacy of Intervention for Engaging Youth and Families into Treatment and Some Variables That May Contribute to Differential Effectiveness." Journal of Family Psychology, 10, 35-44.

Szapocznik, José, William M. Kurtines, Franklin H. Foote, Angel Perez–Vidal, and Olga E. Hervis. 1986. “Conjoint Versus One-Person Family Therapy: Further Evidence for the Effectiveness of Conducting Family Therapy Through One Person.” Journal of Consulting and Clinical Psychology 54(3):395–97.

Szapocznik, J., Perez-Vidal, A., Brickman, A., Foote, F.H., Santisteban, D., Hervis, O.E., & Kurtines, W.M. (1988). "Engaging Adolescent Drug Abusers and Their Families Into Treatment: A Strategic Structural Systems Approach." Journal Counseling & Clinical Psychology, 56: 552-557.

Szapocznik, José, Angel Perez–Vidal, Olga E. Hervis, Andrew L. Brickman, and William M. Kurtines. 1989. “Innovations in Family Therapy: Strategies for Overcoming Resistance to Treatment.” In Richard A. Wells and Vincent J. Giannetti (eds.). Handbook of the Brief Psychotherapies. New York, N.Y.: Plenum Press, 93–114.

Szapocznik, José, Arturo T. Rio, and William M. Kurtines. 1991. “University of Miami School of Medicine: Brief Strategic Family Therapy for Hispanic Problem Youth.” In Larry E. Beutler and Marjorie Crago (eds.). Psychotherapy Research: An International Review of Programmatic Studies. Washington, DC: American Psychological Association, 123–32.

Szapocznik, José, Arturo T. Rio, Edward Murray, Raquel Cohen, Mercedes A. Scopetta, Ana Rivas–Vasquez, Olga E. Hervis, and Vivian Posada. 1989. “Structural Family Versus Psychodynamic Child Therapy for Problematic Hispanic Boys.” Journal of Consulting and Clinical Psychology 57(5):571-78.

Szapocznik, José, and Robert A. Williams. 2000. “Brief Strategic Family Therapy: 25 Years of Interplay Among Theory, Research, and Practice in Adolescent Behavior Problems and Drug Abuse.” Clinical Child and Family Psychology Review 3(2):117–35.

Contact:

José Szapocznik, Ph.D.
University of Miami, Center for Family Studies, Brief Strategic Family Therapy© Institute
1425 N.W. 10th Avenue

Miami, FL 33136

Phone: 1.305.243.7585
Fax: 1.305.243.2320
E-mail: BSFT@med.miami.edu

Web site: www.BSFT.org