Multidimensional Family Therapy FAQs

• What is the background of MDFT?
• What are the goals of MDFT?
• What are the components of MDFT?
• Has MDFT been evaluated?
• Has MDFT been recognized nationally?
• Who do I contact for more information on MDFT?

Background
Multidimensional Family Therapy (MDFT) is an outpatient family-based drug abuse treatment for teenage substance abusers (Liddle, 1992; Liddle, 2002a, 2002b). MDFT has been applied in several geographically distinct settings with a range of populations, targeting ethnically diverse adolescents (White, African-American, and Hispanic) at risk for abuse and/or abusing substances and their families. The majority of families treated have been from disadvantaged inner-city communities.

As a developmentally- and ecologically-oriented treatment, MDFT takes into account the interlocking environmental and individual systems in which clinically referred teenagers reside. The approach is manualized (Liddle, 2002b), training materials and adherence scales have been developed, and we have demonstrated that the treatment can be taught to clinic therapists with a high degree of fidelity to the model (Hogue et al., 1996; Hogue et al., 1998). MDFT is being implemented in state-wide dissemination initiatives and investigators are examining the process of adapting and transporting the model into an existing day treatment drug program for adolescents (Liddle et al., 2002).

Goals
Targeted outcomes in MDFT include reducing the impact of negative factors as well as promoting protective processes in as many areas of the teen's life as possible  Objectives for the adolescent include transformation of a drug using lifestyle into a developmentally normative lifestyle and improved functioning in several developmental domains, including positive peer relations, healthy identity formation, bonding to school and other pro social institutions, and autonomy within the parent-adolescent relationship. For the parent(s), intermediate objectives include: increasing parental commitment and preventing parental abdication; improved relationship and communication between parent and adolescent; and increased knowledge about parenting practices (e.g., limit-setting, monitoring, appropriate autonomy granting).

Core Components
From the perspective of MDFT, adolescent drug use is understood in terms of a network of influences (i.e., individual, family, peer, community). This multidimensional approach suggests that reductions in target symptoms and increases in prosocial target behaviors occur via multiple pathways, in differing contexts and through different mechanisms. The therapeutic process is thought of as retracking the adolescent's development in the multiple ecologies of his or her life. The therapy is phasically organized, and it relies on success in one phase of the therapy before moving on to the next. Knowledge of normal development and developmental psychopathology guides the overall therapeutic strategy and specific interventions.

The MDFT treatment format includes individual and family sessions, and sessions with various family and extra familial sessions. Sessions are held in the clinic, in the home, or with family members at the court, school or other relevant community locations. The therapist helps to organize treatment by introducing several generic themes. These are different for the parents (e.g., feeling abused and without ways to influence their child) and adolescents (e.g., feeling disconnected and angry with their parents). The therapist uses these themes of parent-child conflict as assessment tools and as a way to identify workable content in the sessions.

During individual sessions, the therapist and adolescent work on important developmental tasks such as decision-making and mastery to promote the skills needed to maintain the adolescent on a prosocial track. The teenager is helped to acquire skills in communicating his or her thoughts and feelings and developing skills to better deal with life stressors. Job skills and vocational training are also part of treatment. Parallel to these individual sessions with the adolescent is work with the parents on improving parenting behaviors. Parents are helped to examine their particular parenting style, to distinguish influence from control, and to accept that not everything can or should be changed in order that they have a developmentally appropriate positive influence on their child (Liddle et al, 1998).

The format of MDFT has been modified to suit the clinical needs of different clinical populations. A full course of MDFT ranges between 16 and 25 sessions over four to six months. Sessions may occur multiple times during the week in a variety of contexts including in-home, in-clinic, or by phone. The MDFT approach is organized according to five assessment and intervention modules: 1) Interventions with the Adolescent, 2) Interventions with the Parent, 3) Interventions to Change the Parent-Adolescent Interaction, 4) Interventions with Other Family Members, and 5) Interventions with Systems External to the Family.

Results from MDFT Studies
A systematic program of research has been conducted with MDFT.  This work is documented in our Programs of Study.  Please click here to download a summary of CTRADA research.

MDFT Accomplishments
The MDFT treatment approach has been recognized as one of a new generation of comprehensive, multicomponent, theoretically-derived and empirically-supported adolescent drug abuse treatments (Center for Substance Abuse Treatment, 1999; Lebow & Gurman, 1995; National Institute on Drug Abuse, 1999; Nichols & Schwartz, 1998; Selekman & Todd, 1991; Stanton & Shadish, 1997; Waldron, 1997; Weinberg, Rahdert, Colliver, & Glantz, 1998; Williams & Chang, 2000; Winters, Latimer, & Stinchfield, 1999). MDFT is included in NIDA’s Principles of Drug Addiction Treatment book as one of three empirically supported drug treatments for adolescent drug abuse (http://www.nida.nih.gov; http://www.nida.nih.gov/BTDP/Effective/Liddle.html); in APA’s Division 50 The Addictions Newsletter issue on empirically supported drug therapies (Liddle & Rowe, Spring 2000); and in the OJJDP monograph series on evidence based treatments for delinquency (Liddle, in press). MDFT is also included in the CSAP (http://www.strengtheningfamilies.org/html/programs_1999/10_MDFT.html) and Office of Juvenile Justice and Delinquency Prevention Strengthening Families--Exemplary Programs Initiative. MDFT is highlighted in the United States Department of Health and Human Services Best Practices Initiative (http://phs.os.dhhs.gov/ophs/BestPractice/mdft_miami.htm), and was recently profiled in the Drug Strategies Report on State of the Art Adolescent Drug Abuse Treatments (http://www.drugstrategies.org/pubs.html#teen).  MDFT is also being tested within CSAT’s initiative on Adolescent Treatment Models, formerly known as the funding initiative on Exemplary Adolescent Treatment Programs. The therapy approach and its research program have been recognized with national and other awards from the American Psychological Association (1991), American Family Therapy Academy (1995), American Association for Marriage and Family Therapy (1996), and the Florida Association for Marriage and Family Therapy (2000).

Contact Information
Dr. Howard A. Liddle
Professor and Director
Center for Treatment Research on Adolescent Drug Abuse
Department of Epidemiology and Public Health
University of Miami School of Medicine
1120 N.W. 14th Street, 10th floor
Miami, FL 33136
Phone: (305) 243-6434
Fax: (305) 243-3651
Email: hliddle@med.miami.edu