Multidimensional Family Therapy

Theoretical Basis

MDFT was developed in part from the social ecology theory, which suggests that children develop within several interconnected subsystems, such as schools, peer groups, neighborhoods, and families. By understanding and working with the influence of the subsystems that surround the troubled adolescents, lasting behavior changes are thought to be possible.

Research in adolescent developmental psychology and psychopathology has shown that the family is the main context of healthy identity formation, that peer influence operates in relation to the buffering effect of the family against a possibly deviant peer subculture, and that adolescents require the development of an interdependent (as opposed to emotionally separated) relationship with their parents. MDFT was created to allow for symptom reduction and the enhancement of prosocial and normative developmental functions by targeting the family as the basis for the intervention while at the same time allowing for curative processes to develop in several domains of functioning and across multiple systemic levels.

Structure

MDFT is recognized internationally as among the most effective treatments for adolescent substance misuse and has been developed and tested in different forms, increasing the flexibility of the program. This flexibility allows the format and components of MDFT to be modified to specifically meet the needs of different clinical populations. Sessions may occur multiple times during the week and can be tailored to take place in a variety of contexts such as in the home, in the MDFT clinic, in community settings, or by phone. The program is designed to produce behavioral changes in 3 to 6 months using 12 to 25 therapy sessions.

Session content may vary according to the stage of treatment; however, four assessment and intervention modules structure the approach within three stages. Stage one includes a comprehensive assessment covering the problems areas as well as areas of strength that the adolescent may possess and that may not be currently utilized. Assessment in MDFT is important in directing therapists as to where intervention is needed among the myriad of domains within an adolescent's life.

Stage two is the working phase of the treatment during which the therapist attempts to help the patient make significant changes within and across individual, family, peer, school, and other subsystems. The focus during this stage of treatment is on the facilitation of developmentally appropriate competence across a multitude of areas of the patient's life while teaching individualized communication and problem-solving skills. During this stage, parents are helped to examine their relationship with their child, as well as the strategies they use to influence their child. The therapists work to change negative family interaction patterns in order to change the family's everyday environment and to coach parents on innovative ways of reaching out to their children.

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