Miller School of Medicine, University of Miami, USA.
J Consult Clin Psychol. 2011 Feb;79(1):43-53. doi: 10.1037/a0022146.
Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents who received brief strategic family therapy within a multisite effectiveness study.
Participants were 480 adolescents (age 12-17) and their family members, who were randomized to the Brief Strategic Family Therapist treatment condition (J. Szapocznik, U. Hervis, & S. Schwartz, 2003) or treatment as usual. The adolescents were mostly male (377 vs. 103 female) and Hispanic (213), whereas 148 were White, and 110 were Black. Therapists were also randomly assigned to treatment condition within agencies.
Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use.
Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy.
治疗师的依从性已被证明可以预测家庭治疗的临床结果。在之前的研究中，依从性主要通过核心原则和一致的家庭（而非个体）焦点来表示。迄今为止，这些研究尚未捕捉到复杂的基于家庭的方法中所代表的一系列临床技能，也没有研究这些技能的变化如何在治疗过程中预测不同的临床相关结果。在这项研究中，作者在一项多地点有效性研究中，检查了一种观察性依从性测量的可靠性和有效性，以及在接受简短战略家庭治疗的吸毒青少年样本中，依从性与结果之间的关系。
参与者为 480 名青少年（年龄 12-17 岁）及其家庭成员，他们随机分配到简短战略家庭治疗师治疗条件（J. Szapocznik、U. Hervis 和 S. Schwartz，2003 年）或常规治疗。青少年中男性（377 名对 103 名女性）和西班牙裔（213 名）居多，而 148 名是白人，110 名是黑人。治疗师也在机构内随机分配到治疗条件。
结果支持该依从性测量的拟议因素结构，这表明有可能捕捉和区分家庭治疗的不同维度。分析表明，各因素的平均水平在理论上和临床上以相关的方式随时间变化，治疗师的依从性与治疗中的参与和保留、家庭功能的改善以及青少年药物使用的减少有关。
讨论了临床意义和未来的研究方向，包括这些发现对培训治疗师的相关性以及对家庭治疗中作用机制的研究。
