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CFT INTERVENTIONS

The Effectiveness of Couple and Family -Based Clinical Interventions
by

Chrisola Ham

on 22 April 2015

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Transcript of CFT INTERVENTIONS

The Effectiveness of Couple and Family Based
Clinical Interventions

RECOMMENDATION: practitioners/researchers keep in mind that therapist & client factors moderated tx outcome
therapist with more structure are able to demonstrate mastery of technical skills seemed better able to prevent worsening of family interactions
directive approaches were more successful than the less directive methods
family treatments were a viable, vehicle for change when compared to no treatment & alternative treatments
MEDIATORS OF CHANGE: reduction of negativity within therapy sessions, improved family communication, therapist-family alliance, & systematic structuring sessions
Evolution of CRT Research
CURRENT REVIEW





REVIEW AND RATING PROCEDURES



REVIEW METHODOLOGY





^Field moved away from reductionist
approach & moved toward research
methods (Seedall, Sprenkle, & Lebow, 2011;
Sexton et al 2007)
TERMINOLOGY
Couple & Family Therapy (CFT)
Randomized Clinical Trials (RCT)
Couple Therapy (CT)
Family Therapy (FT)
Behavioral Couple Therapy (BCT)
Emotionally Focused Couple Therapy (EFCT)
Empirically Supported Treatment (EST)
Functional Family Therapy (FFT)
Multisystemic Therapy (MST)
Domestic Violence Focused Couple Therapy
(DVFCT)
Agency of Healthcare Research & Equality & Effective Health-Care Program (AHRQ)

^(RCT) have provided a valuable tool to validate absolute relative efficacy (Kazdin, 2006).
^
CFT models "family intervention science,“ a growing body of outcome and process studies that meet the highest standards of research methodology.
^ Research reviews are helpful tools for bringing science & practice together.
^building a bridge between CFT research and practice.
^past 3 editions of Handbook of Psychotherapy
& Behavior Change (1978, 1986, 2004)
have chronicled evolution of
CFT intervention research.



*Individual studies=82.3% addressed family therapy or parenting programs & 17.7% couple therapy
*Family interventions were much more likely to be less specific-more applicable to
non-Hispanic, White families
*Couple focused on identifiable intervention & therapeutic models

RANGE OF RESEARCH EVIDENCE (CFT)
results of analysis helped identify practices that were effective overall & in treatment of particular groups of clients with specific problems
rating method based on AHRO; completed by 4-member rating team; rated in 7 different areas
Organized into 2 sections: (1) CFT research/influence in clinical practice (2) effectiveness of CFT interventions/identifies positive outcome interventions
QUALITY OF STUDIES
quality of study determines degree of confidence field might have in findings of CFT research
TRENDS, ISSUES, & STATE OF CFT
STATE OF CFT INTERVENTION RESEARCH LITERATURE
CFT STUDIES
rigorous standards/strongly methodological
relevant comparison groups/random assignments
large sample sizes & measured fidelity in systematic fashion
programs based on high-quality studies in community based settings w/ diverse cts
address wide range of clinical problems
broad and forms a strong and a helpful comprehensive knowledge base to answer clinical questions

- Studies of family treatment focus most
on behavior issues.
-More focused on therapeutic programs than individual clinical interventions
- target specific clinical problems
& populations
- Possible emerging trend in
research/clinical practice
CFT
Literature
1. (a) methodologically sound, clinically specific community-based
(b) narrow-focused
(c) studies don't represent diverse problems or diverse clients
(d) focused on specific comprehensive programs

2. suggests concern w/ availability of programs
designed for specific clinical problems
CFT Research
1. complex statistical & methodological approaches

2. focuses on outcomes of interventions/programs

3. focuses on family therapy w/ less studies aimed toward investigating couple therapy

EFFECTIVENESS OF FAMILY-BASED INTERVENTIONS
^Family therapy produced positive results for wide variety of specific clinical problems & some intervention were more effective than individual or standard tx for a number of disorders

^those receiving family-based interventions fared better than those receiving no treatment (Shadish, Ragsdale, Glaser, & Montgomery, 1995)

^FT better result than tx-as usual groups, but few studies compared relative effectiveness of different types of FT
Family-Based Clinical Intervention
>parent skills training
-directed at altering skills of parent(s) in order to improve function of youth

INDIVIDUAL STUDIES = 4 COMPREHENSIVE PARENTING PROGRAMS


<parent child interaction training (PCIT)
-family-based parenting program for young children; 2-7 yr old

<Triple P positive parenting program
-manualized intervention for children & younger adolescents; delivered to individual, group, & family settings

<incredible years parent training (IYPT)
-curriculum-based parenting intervention program focused on improving youth behavior problems & parent-child conflict; community & agency settings
<parent management training (PMT)
-manualized, parent-training program focused on behavior problems in children; youth ages vary & severity of externalizing problems; behavior management through psychoeducational initiatives w/ caregivers that focus on core parental processes

<general parent training(PT)
-group of nonspecific intervention that are oriented toward development of parenting skills & management of child & adolescent behavior
Family Therapy Interventions
>Previous handbooks found number of of specific family therapy programs were effective & that the research on these models was strong (Sexton et al., 2003)
Clinical Problems Effective w/ CT
INVESTIGATED PROBLEMS

relationship satisfaction

alcohol/substance use/abuse

infidelity

intimate partner violence

general mental health & depression
=Adopt & use systematic treatments when available.
=More comparative effectiveness trials


a). produce knowledge about intervention programs; provide developers w/ info for further program development & refinement.

=Using diverse research methods


a). Gold standard of clinical intervention research
b). RCT’s expensive/complex
c). diverse research methods w/ nonrandomized comparison groups, correlational designs, & lower levels of methodological power-parameters associated w/ delivery of tx, ct characteristics, & type of clinical settings.

CFT Research/Practice Next Generation
=Expand range of tx programs & interventions studied
a).
Long-standing research activities show how intervention can be evaluated systematically/rigorously w/ different clients

= Broaden the Range of Clinical Problems Studied.

a). Common techniques require specific definitions

b). Common factors of CFT must be specified.

c). Clinical intervention programs (MST, BCT) must focus on change mechanisms or “how” & “why” positive outcomes occur in highly specific & comprehensive approaches.

d). W/o change mechanism research, program developers do not have evidence-based information about specific components of program & how they work to produce specific outcomes.
= Expand CFT Research Beyond the Study of Outcomes
= Study variables that may increase
efficacy of CFT
when implemented
in community settings.
d). Feedback systems allow clinicians responsibility for monitoring effectiveness of their interventions.

c). Lambert & Bickman, Kelley, Breda, de Andrade, & Riemer -advanced computer technology gives practitioners instant access to data regarding proximal outcomes & core therapeutic mechanisms.
b). Hogue -curvilinear relationship b/t adherence & outcome (when therapists gained experience, adherence appears to hinder rather than improve outcomes)
a). Sexton and Turner-model adherence directly related to successful community outcomes.

a). Practitioners may disregard research due to not all clinical problems are investigated & shown to be influenced by specific treatment approaches.

b). Always gaps in research literature.

c). Research will never answer all complex questions of clinical practice.

d). Professional wisdom of mental health providers -bringing creativity & art to practice most specific & systematic intervention program.
=Adopt emerging methods for systematic review & treatment guidelines.
a). Emphasized promotion of accuracy & transparency of scientific reviews to facilitate well-informed decisions.
b). Reviews clear judgments about strength of evidence supporting specific treatment programs
c). Systematic reviews may be translated into practice guidelines that consist of specific treatment recommendations
INDIVIDUAL STUDIES: 5 TYPES OF INTERVENTIONS: 4=SYSTEMATIC INTERVENTION programs & 1 GENERAL FT

<multisystemic therapy
-treat youth w/ serious antisocial behaviors; empower caregivers to increase protective factors;
<functional family therapy (FFT)
-youth w/ behavior, substance use, & family relational problems; juvenile justice,
& community mental health centers (Alexander & Sexton, 2002; Sexton et al., 2004; Sexton & Turner, 2010)
<multidimensional family therapy (MDFT)
- substance abusing youth & their family; best practice (National Institute on Drug Abuse; NIDA, 1999); multisystem, manualized, phasic approach targets multiple risk & protective factors across divers social domains of adolescent & family functions
<cognitive behavior family therapy
-individual therapy implemented w/ family; incorporate parents into an establish cognitive behavioral tx for youth in order to improve outcomes via parent training or support (Freeman et al., 2008; Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg, 2008)

Clinical Problems Effective w/ FT
Child & Youth behavior problems

Youth Substance Use/Abuse Problems

Youth Bipolar, Depressive Disorder, & General Medical conditions
COUPLES THERAPY INTERVENTIONS PROGRAMS
target couple relationship; couple-based clinical intervention; improve relationship satisfaction & variety of individual clinical symptoms one couple member may experience
Moderators & Mediators of
CFT Intervention

Based on research which identifies &
assist w/ discovering practices which
improve outcomes; guides clinicians
use for interventions
Lindsey
Suzanne
Chrisola
Domains of mediators &
moderators

clinical research alliance
model-specific fidelity
specific client factors
Understanding:

`Know what works
`intervention challenges
`clinically emphasize improvement of outcome
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