Running head: MULTIDIMENSIONAL FAMILY THERAPY

Multidimensional Family Therapy for Adolescents

with Substance Abuse or Behavior Issues
Len Peters
Counsl 622
University of Massachusetts Boston

MULTIDIMENSIONAL FAMILY THERAPY

Multidimensional family therapy for adolescents with substance abuse or behavior issues
This paper will look at how multidimensional family therapy (MDFT) approaches
substance abuse and behavior issues among adolescent youth. I chose this topic because in my
internship, I am encountering numerous students who are either using drugs, have substantial
behavior issues, or both. The students I work with are predominantly black, and more than 50%
of them live in single parent homes, or extended family homes, without the father present. I see
the teachers struggling to help them learn, and I see the parents frustration in trying to
communicate with their children. I often see openness in the students towards their parents, and
believe that door is not firmly closed. I hope to have a better understanding of how MDFT
addresses these issues.
Howard Liddle has been influential in developing MDFT. His approach integrates
developmental psychopathology, family systems theory, social support theory, peer cluster
theory, social learning theory, and the risk factor models of drug and problem behavior (Nichols,
Schwartz, and Richard, 2012). Liddle (1999) suggests the developmental processes of attachment
and caregiving ideally would precede communication, joint problem solving, and mutuality.
Unfortunately for many single mothers, this process has not occurred, and parental competency
is handicapped. MDFT is a strength based approach that works to improve or restore attachment
bonds between parent and adolescent, while at the same time recognizing the parent is an
individual with her/his own needs and concerns, apart from the parenting role (Becker and
Liddle, 2001).
The principles of MDFT emphasize a focus on the adolescents problems, strengths, and
goals, as well as looking at the parent issues, parenting and family relationships, and
extrafamilial factors (Hogue, Dauber, Samuolis and Liddle, 2006). MDFT looks at assets as well

MULTIDIMENSIONAL FAMILY THERAPY

as areas of strength both hidden and apparent, and forms a clinical view of the adolescent and
family, based on these strengths and weaknesses in the young person, the family, and their social
context. This process draws on the family therapy theory of discovering dysfunctional family
transactional patterns, and showing the link to the development of maladaptive behaviors
(Liddle, 2010).
Adolescent substance abuse, and frequent maladaptive behavior correlates, transit on
varied developmental paths, and as such, are not amenable to a single psychotherapeutic
intervention. Liddle (2004) states empirical knowledge provides an expanded conceptualization
of adolescent substance abuse. He suggests social-cognitive factors; personality and
temperament; family factors; peer relationships; school and community influences; sociocultural
factors; and other such factors have empirical links to the development and continuance of
adolescent substance abuse. As a result of this understanding, a multidimensional system of
therapy is needed in order to address these complex interrelated factors. All of these factors,
viewed as interpersonal and intrapersonal influences, are considered in conceptualizing an
individual case (Liddle, 2004). The behavior is representative of maladaptive, unhealthy
development.
There are four realms of treatment for MDFT: adolescents, parents and other members of
the family, the patterns of family interaction, and the influences from extrafamilial systems.
Hogue et al (2006) indicate the four realms are empirically related to knowledge about the
developmental psychopathology of adolescent substance abuse, as well as recognized areas of
risk and protection for adolescents and their families. These four realms become the four
intervention targets. Utilizing research supported knowledge about how adolescent substance use
develops, the therapist investigates the details and functioning of each target area (Liddle, 2010).

MULTIDIMENSIONAL FAMILY THERAPY

Each area is of equal importance, and the therapist works proportionally in each area according
to the risk and protection profile obtained for the adolescent and their family (Hogue et al, ). The
therapist works to help the adolescent learn about how they think and feel, improve
communication with their parents and other adults, be more successful in resolving social
problems, manger their anger and emotions, and choose alternative behaviors. Parents
interventions include increasing their emotional and behavioral involvement in their adolescents
life, improve limit setting, and be more effective in monitoring, rather than controlling, their
adolescent (Hogue, Dauber, Samuolis, and Liddle, 2006).
In MDFT, it is essential the therapist develops a strong alliance with both the parent(s),
and the adolescent. In developing this alliance, the therapist takes an active, directive, and
supportive stance, attempting to guide, coach, and see that family conversations are as positive
and constructive as possible (Liddle, 2010). Becker and Liddle (2001) discuss the importance in
working with African American single mothers to develop this alliance. They note the mother
entering therapy is at risk of being blamed for their teens behavior, as well as now being largely
responsible for ensuring the therapy is beneficial. The therapists empathic alliance with the
mother in this case can provide the mother with the intrapersonal skills, and empathic ability to
be able to sustain an empathic relationship with her adolescent (Becker and Liddle, 2001).
Hogue, Dauber, Stambaugh, Cecero, and Liddle (2006) found a strong therapeutic alliance with
the parent(s) was a significant predictor of improvement in the adolescent. They found a weak
initial alliance with the adolescent was likely to develop into a strong alliance, and thus allow a
successful intervention. Curiously, they a strong initial alliance was more likely to develop into a
conflictual relationship, and an ineffective intervention.

MULTIDIMENSIONAL FAMILY THERAPY

Liddles approach, particularly working with African American families, has been to use
the structural family technique of enactment to effect direct, in-session changes in the
adolescent-family interactions (Nichols et al., 2012). This technique involves eliciting broad
themes or issues that are important to the family, and then working with the family and
adolescent conjointly, or with individual members, to develop the skills to meet these problems
in new and positive ways (Liddle, 2010). Developing intrapersonal and interpersonal skills in all
family members is key, with each session working to cultivate positive and constructive
interactions. The therapist will take the adolescent out of the therapy room for an individual
session, during a family session, if that is considered worthwhile. These private conversations
can be a forum to discuss personal issues of gender or sexuality, as well as important
relationships outside the family (Nichols et al., 2012). In all sessions, the therapist works to
develop the skills in each member that will enable problem solving and honest communication,
without casting blame, being defensive, or imparting guilt by any family member (Liddle, 2010).
Writing this paper has helped me more deeply understand the theoretical and practical
aspects of MDFT. I have a greater appreciation of the dynamics that can occur in the therapy
sessions, as well as the unique possibilities MDFT offers. It makes sense that a complex,
multifaceted problem such as adolescent behavior, or breakdown in parent/child communication,
would be more effective through a synergistic approach drawing from multiple theoretical
perspectives. Reading the various articles was again a reminder of the immense value of
validating theories through rigorous research, and then trying to bring that research into our work
and not just resting with what we know. I was particularly struck by how much work Howard
Liddle has done with African American families, and how successful this work has been. It gives

MULTIDIMENSIONAL FAMILY THERAPY

me hope that we can find a way to get this kind of support for those families in need at my
internship school.

MULTIDIMENSIONAL FAMILY THERAPY

References
Becker, D., & Liddle, H. A. (2001). Family therapy with unmarried African American mothers
and their adolescents. Family Process, 40(4), 413-429.
Hogue, A., Dauber, S., Samuolis, J., & Liddle, H. A. (2006). Treatment techniques and outcomes
in multidimensional family therapy for adolescent behavior problems. Journal of Family
Psychology, 20(4), 535-543. doi:10.1037/0893-3200.20.4.535
Hogue, A., Dauber, S., Stambaugh, L. F., Cecero, J. J., & Liddle, H. A. (2006). Early therapeutic
alliance and treatment outcome in individual and family therapy for adolescent behavior
problems. Journal of Consulting and Clinical Psychology, 74(1), 121-129. doi:
10.1037/0022-006X.74.1.121
Liddle, H. A. (2010). Multidimensional family therapy: A science-based treatment system. The
Australian And New Zealand Journal Of Family Therapy, 31(2), 133-148.
Nichols, M. P., & Schwartz, R. C. (2012). Family therapy: Concepts and methods. (10th Ed.).
Prentice Hall. Kindle Edition.