How to Coach Yourself and Others Coaching Families | Page 79

Chapter 6 - Clinical Research Supporting Brief Stategic Family Therapy
This chapter describes past research on the effectiveness of BSFT with drug-abusing adolescents with
behavioral problems. BSFT has been found to be effective in reducing adolescents' conduct problems, drug
use, and association with antisocial peers and in improving family functioning. In addition, BSFT
engagement has been found to increase engagement and retention in therapy. Additional studies testing an
ecological version of BSFT with this population are currently underway.
As presented in this manual, BSFT's primary emphasis is on identifying and modifying maladaptive patterns
of family interaction that are linked to the adolescent's symptoms. The ecological version of BSFT, BSFTecological (Robbins et al. in press) applies this principle of identifying and modifying maladaptive patterns
of interaction to the multiple social contexts in which the adolescent is embedded (cf. Bronfenbrenner
1979). The principal social contexts that are targeted in BSFT-ecological are family, family-peer relations,
family-school relations, family-juvenile justice relations, and parent support systems. Joining, diagnosing,
and restructuring, as developed in BSFT to use within the family system, are applied to these other social
contexts or systems that influence the adolescent's behaviors. For instance, the BSFT counselor assesses the
maladaptive, repetitive patterns of interaction that occur in each of these systems or domains. As an
example, the BSFT counselor would diagnose the family-school system in the same way that he or she
would diagnose the family system. In diagnosing structure, the counselor would ask, "Do parents provide
effective leadership in their relationship with their child's teachers?" In diagnosing resonance, the counselor
would ask, "Are parents and teachers disengaged?" In diagnosing conflict resolution, the counselor's
questions would be, "What is the conflict resolution style in the parentteacher relationship? Might parents
and teachers avoid conflict with each other (by remaining disengaged) or diffuse conflicts by blaming each
other?" In BSFT-ecological, joining the teacher in the parentteacher relationship employs the same joining
techniques developed for BSFT. Similarly, in BSFT-ecological, BSFT restructuring techniques are used to
modify the nature of the relationship between a parent and his or her child's teacher.
Outpatient Brief Strategic Family Therapy Versus Outpatient Group Counseling
A recent study (Santisteban et al. in press) examined the efficacy of BSFT in reducing an adolescent's
behavioral problems, association with antisocial peers, and marijuana use, and in improving family
functioning. In this study, outpatient BSFT was compared to an outpatient group counseling control
treatment. Participants were 79 Hispanic families with a 12- to 18-year-old adolescent who was referred to
counseling for conduct and antisocial problems by either a school counselor or a parent. Families were
randomly assigned to either BSFT or group counseling. Analyses of treatment integrity revealed that
interventions in both therapies adhered to treatment guidelines and that the two therapies were clearly
distinguishable.
Conduct disorder and association with antisocial peers
Conduct disorder and association with antisocial peers were assessed using the Revised Behavior Problem
Checklist (RBPC) (Quay and Peterson 1987), which is a measure of adolescent behavior problems reported
by parents. Conduct disorder was measured using 22 items, and association with antisocial peers was
measured using 17 items. Each item asks the parent(s) to rate whether a specific aspect of the adolescent's
behavior (e.g., fighting, spending time with "bad" friends) is no problem (0), a mild problem (1), or a severe
problem (2). Ratings for all items on each scale are then added together to derive a total score.
The effects of BSFT on conduct disorder, association with antisocial peers, and marijuana use were
evaluated in two ways. First, analyses of variance were conducted to examine whether BSFT reduced
conduct disorder, association with antisocial peers, and marijuana use to a significantly greater extent than
did group counseling. Second, exploratory analyses were conducted on clinically significant changes in
conduct problems and association with antisocial peers. These exploratory analyses used the twofold
clinical significance criteria recommended by Jacobson and Truax (1991). To be able to classify a change in
symptoms for a given participant as clinically significant, two conditions have to occur. First, the magnitude
of the change must be large enough to be reliable--that is, to rule out random fluctuation as a plausible
explanation. Second, the participant must "recover" from clinical to nonclinical levels, i.e., cross the
diagnostic threshold.

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