Bonnaire C, Bastard N, Couteron J-P, Har A, Phan O
Centre Pierre-Nicole, 27, rue Pierre-Nicole, 75005 Paris, France; Laboratoire de psychopathologie et processus de santé, université Paris Descartes, Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92774 Boulogne-Billancourt, France.
Clinique Dupré, 30, avenue du Président-Franklin-Roosevelt, 92333 Sceaux, France.
Encephale. 2014 Oct;40(5):408-15. doi: 10.1016/j.encep.2013.04.018. Epub 2013 Aug 28.
Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy.
The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method.
The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they work with the system and the subsystem, focusing on the emotional expression and the parental and adolescent enactment (a principle of change and intervention). MDFT includes four modules (adolescent, parent, family interaction, and extra-familial systems) in three steps (1) build the foundation, (2) prompt action and change by working the themes, and (3) seal the changes and exit). The supervision philosophy and methodology is also based on the principle of multidimensionality. Indeed, many different supervision methods are used in a coordinated way to produce the required adherence and clinical skill (written case conceptualizations, videotape presentation and live supervision).
Family vulnerability and chronicity factors are a major challenge of modern research. MDFT questions the reciprocal adjustments that have to be made by the subject and his/her familial environment. It also helps to clarify the therapeutic interventions in order to enhance better adolescent development. For this purpose, MDFT offers a specific therapeutic frame, for it is a family therapy focused on adolescents with cannabis abuse problems. Its action and questioning on parental practices and adolescents lead to better psycho-educational support. It focuses the therapeutic process on emotions and family capacity for change.
在非法精神活性药物中，大麻是法国青少年消费最多的。多维家庭治疗（MDFT）是一种基于家庭的门诊治疗方法，专为有药物和行为问题的青少年开发。MDFT不仅在美国，而且在欧洲（国际大麻治疗需求项目）都已证明其对患有物质使用障碍（尤其是大麻滥用）的青少年有效。MDFT是一种多学科方法和循证治疗，处于发展心理学、生态理论和家庭治疗的交叉点。其心理治疗技术源于多种方法，包括系统家庭治疗和认知治疗。
本文的目的是：通过突出其特点来描述MDFT的所有背景；解释结构和策略治疗如何影响这种方法；探讨MDFT、简短策略家庭治疗和多系统家庭治疗之间的联系；并强调这种家庭治疗方法的特殊性。
多维家庭治疗基于以下两点创建：1）整合源自各种家庭治疗理论的多种治疗技术；2）已证明家庭治疗有效性的研究。多项试验表明，与团体治疗、认知行为治疗和家庭治疗相比，MDFT具有更高的效率。研究还强调，MDFT能带来更好的治疗效果，尤其是在有严重药物使用和精神共病的年轻人中。在系统家庭治疗领域，MDFT受到以下影响：1）结构家庭治疗（S. 米纽钦），2）策略家庭理论（J. 哈利），3）代际家庭治疗（鲍文和博佐门伊 - 纳吉）。MDFT有其特殊之处：MDFT治疗师从多维角度思考（因为青少年药物滥用是一种多维障碍），他们与系统和子系统合作，关注情感表达以及父母与青少年的互动表现（一种改变和干预原则）。MDFT包括四个模块（青少年、父母、家庭互动和家庭外系统），分三个步骤进行（1）奠定基础，（2）通过处理主题促使行动和改变，（3）巩固改变并结束）。督导理念和方法也基于多维原则。事实上，许多不同的督导方法以协调的方式使用，以产生所需的依从性和临床技能（书面案例概念化、录像展示和现场督导）。
家庭脆弱性和慢性因素是现代研究的一大挑战。MDFT质疑个体与其家庭环境必须做出的相互调整。它还有助于阐明治疗干预措施，以促进青少年更好地发展。为此，MDFT提供了一个特定的治疗框架，因为它是一种针对有大麻滥用问题青少年的家庭治疗。它对父母行为和青少年的作用及质疑能带来更好的心理教育支持。它将治疗过程聚焦于情感和家庭的改变能力。
