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Systemic theories addressing posttraumatic stress disorder (PTSD) in couples postulate associations between primary trauma survivor functioning, secondary trauma survivor functioning, and couple functioning. However, there is a lack of examination of the association between secondary trauma survivor functioning and couple functioning, which has clinical implications. Objectives of this study include informing clinicians of the evidence base for these associations and providing a synthesized review of research on PTSD in couples to inform future research. A systematic research synthesis screening 150 articles from three databases resulted in the inclusion of 15 quantitative articles to examine the quality of the available research addressing the association between secondary trauma survivor functioning and couple functioning. Correlation matrices in all studies and other partial evidence supported the current theory positing the relevance of secondary traumatic stress in interpersonal functioning for couples. Discussion includes the need for increased quality and diversity of systemic trauma research and treatment for couples.

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Difficulties in various cognitive functions are common observations in people experiencing anxiety. However, limited research has investigated the effects of psychotherapy on abnormal cognitive functioning. This study assessed whether psychotherapy-related reductions of anxiety result in improvements of cognitive functioning as well. Fifty-four participants with high self-reported anxiety, divided into two experimental groups (N = 28 and N = 26), and 27 non-anxious control participants (N = 27) completed a battery of memory tasks and anxiety questionnaires in three consecutive time points. In experimental group 1, participants started systemic family therapy immediately after the first time point, while, in experimental group 2, participants begun the same type of therapy three months later at the second time point. The results showed that, compared to control participants, at the beginning of the experiment, participants in the experimental groups had significantly lower memory performance, along with higher anxiety. Psychotherapy had a beneficial effect on anxiety symptoms and cognitive performance, with significant changes occurring only after intervals of treatments. These results show that psychotherapy is effective not only in reducing anxiety symptoms but on cognitive functioning as well. This improvement might be linked to the release of cognitive resources previously absorbed by worrisome thoughts, facilitated by a heightened protection from interference.

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This paper introduces the Attachment Mapping Protocol (AMP), which is an assessment and treatment tool for use in individual psychotherapy, systemic family therapy and multifaith spiritual care, using a bio-psycho-social-spiritual model of care. Attachment theory has a long and significant history in psychology, with an evolving relationship within the above clinical domains. A central aim of this paper will be to recognize and affirm the extension of attachment theory beyond the traditional parameters of nascent parental, guardianship bonds and individual, developmental psychology, to reveal a much broader spectrum of valid attachment considerations for mental health and spiritual well-being. A case study will be applied to the interviewing instrument to demonstrate its utility for broadening assessment beyond attachment figures to include surrogate attachments of other persons, places and things. A model of spiritual discernment derived from the Spiritual Exercises of Ignatius of Loyola will undergird this larger worldview of attachment considerations.

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The ward for the treatment of eating disorders was reconceptualized in the context of the reopening of the Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik in Hall in Tyrol. The focus is on systemic-family-therapeutic approaches, interdisciplinarity and groups offered for adolescents and their families struggling with an eating disorder. In addition, the ward will be expanded for adolescents with obesity who also suffer from a psychological comorbidity. Transparency, personal responsibility and voluntariness are lived in a collaboration with adolescents and their families in a multimodal treatment team.

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In Ireland, traditionally, most public Adult Mental Health Services (AMHSs) had a small cohort of service users with eating disorders (EDs) in their service. However, over the last 5 years, the National Clinical Programmes have been encouraging Mental Health Services to develop ED programmes in each catchment area. This has culminated in a model of care for EDs for children and adults. It appears that in relation to AMHSs, meaningful inclusion of families/significant other(s) in ED programmes is somewhat inconsistent. This paper will discuss the possible impact of excluding or minimising family/significant other(s)' inclusion. It will also outline a suggested approach of including families/significant other(s) in a meaningful way in an out-patient ED programme.

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BACKGROUND: Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual. METHODS: A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available. RESULTS: At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040). CONCLUSIONS: Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.

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Family therapy is growing around the world including in many parts of Africa. Although the African continent has many mental and family health needs that family therapists are well-suited to treat, barriers to the widespread application of family therapy on the African continent remain. In this article, we review the current state of systemic family therapy (SFT) in Africa. Drawing from existing literature, we discuss past, current, and future trends, including challenges related to the training and implementation of SFT in Africa. We devote sections of this article to discussing the historical and cultural context, including the fit for family therapy, along with ongoing initiatives in various African countries, using examples from three African countries. We emphasize and discuss the influence of Western models of family therapy in informing family therapy research, training, and implementation in Africa and discuss implications for the African context.

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Constructionist approaches in the field of systemic family therapy prioritize reflexivity to promote personal development within training, often leaning on group processes. Drawing from a qualitative study we conducted to address the lack of related research, we present how systemic family therapy trainees experience reflexivity development through group processes. Ten systemic family therapy trainees participated in semi-structured interviews, transcribed and analyzed with interpretative phenomenological analysis. Analysis presented here reports three superordinate themes: Developing reflexivity through challenges and rewards, A conditional reflexive space within the training group, and Encountering the dynamics of identity via reflexive group processes. Our findings suggest that trainees experience reflexivity development as a complex relational process of personal development, highlighting the training group's critical role, nonetheless depending on certain preconditions. The importance of further exploring group processes' potential for reflexivity development in psychotherapy training is underscored.

Lo enfoques construccionistas en el ámbito de la terapia familiar sistémica priorizan la reflexividad para promover el desarrollo personal dentro de la capacitación, generalmente apoyándose en procesos grupales. Valiéndonos de un estudio cualitativo que realizamos para abordar la falta de investigaciones relacionadas, presentamos la manera en la que los practicantes de la terapia familiar sistémica experimentan el desarrollo de la reflexividad mediante procesos grupales. Diez practicantes de terapia familiar sistémica participaron en entrevistas semiestructuradas, transcriptas y analizadas con el análisis fenomenológico interpretativo. Los análisis presentados aquí informan tres temas superordinados: el desarrollo de la reflexividad mediante desafíos y recompensas, un espacio reflexivo condicional dentro del grupo de capacitación, el encuentro de la dinámica de identidad mediante procesos grupales reflexivos. Nuestros hallazgos sugieren que los practicantes experimentan el desarrollo de la reflexividad como un proceso complejo de desarrollo personal relacional que destaca el papel fundamental del grupo de capacitación, pero que depende de ciertas precondiciones. Se subraya la importancia de analizar con mayor profundidad la posibilidad de desarrollo de la reflexividad en los procesos grupales durante la capacitación en psicoterapia.

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The traditional model of psychiatric assessment and diagnosis can be criticised as reductive. We developed an innovative model for psychiatric assessment of adult patients referred to our adult mental health team, the Systemic Assessment Clinic, incorporating the principles and techniques of systemic family therapy and dialogical practice into standard psychiatric assessment. We conducted a service evaluation, comparing prospective use of mental health services for patients assessed either in the Systemic Assessment Clinic or in standard assessment. Patients assessed in the Systemic Assessment Clinic had more favourable outcomes than those in standard assessment: they were significantly less likely to need multiple follow-up treatment appointments with a psychiatrist and to be re-referred to mental health services once discharged, indicating reduced healthcare costs. Satisfaction rates for participants attending the systemic assessment clinic were high. Our service evaluation gives preliminary evidence that the Systemic Assessment Clinic could be a potential new model for psychiatric assessment; further evaluation is warranted in a randomised controlled trial.

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Investigou-se a percepção de cinco terapeutas de família acerca da monoparentalidade feminina e o papel dos estudos de gênero em sua formação profissional. Para tanto, utilizou-se de entrevista individual semidirigida. A análise crítica de discurso com abordagem sistêmica foi empregada, enfatizando os micro e macroelementos presentes nos discursos. Os resultados indicaram uma defasagem de estudos de gênero na formação básica das profissionais, que foi em parte suprida pela formação em Terapia Familiar Sistêmica. Percepções contraditórias e complementares caracterizaram o processo de análise dos dados. Ao se referirem às mulheres chefes de família e às suas relações com o contexto socioambiental e familiar, as falas variaram entre vieses de patologia e de promoção de saúde. Tais variações foram divididas entre a visão clínica e psicossocial do fenômeno e exigiram um posicionamento crítico de análise dos dados.

We have investigated the perception of five family therapists about femaleheaded single parenting and the role of gender studies in their professional training. Both, an Individual semi-structured interview and the Critical Discourse Analysis together with a systemic approach emphasizing micro and macro elements present in the discourses were applied. The results indicated a lack of gender studies in the professionals’ basic training, which was partly compensated by the training in Systemic Family Therapy. Contradictory and complementary views were parts of the process of data analysis. When referring to female breadwinner and their relationships with environmental and family context, the discourses ranged from pathology biases and health promotion. Such variations were divided between clinical and psychosocial view of the phenomenon and required a critical positioning towards the data analysis.

Fue investigada la percepción de cinco terapeutas de familia acerca de la monoparentalidad femenina y el rol de los estudios de género en su formación profesional. Para tal fueron utilizadas entrevistas individuales semidirigidas. El análisis crítico del discurso siguiendo un enfoque sistémico fue utilizado, haciendo hincapié entre micro y macro elementos presentes en los discursos. Los resultados indicaron una insuficiencia de estudios de género en la formación básica de los profesionales, que fue compensada en parte por la formación en terapia familiar sistémica. Ideas contradictorias y complementarias caracterizan el proceso de análisis de datos. Cuando se hace referencia a mujeres jefas de familia y sus relaciones con el contexto ambiental y familiar, las intervenciones variaron entre sesgos de patología y promoción de la salud. Tales variaciones se dividieron entre el punto de vista clínico y psicosocial del fenómeno y exigieron un posicionamiento crítico del análisis de los datos.

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BACKGROUND: Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. METHODS: One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. DISCUSSION: We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03350594 . Registered on 22 November 2017. IDRCB number 2016-A00818-43.

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Mental health problems during adolescence constitute a major public health concern today for both families and stakeholders. Accordingly, different family-based interventions have emerged as an effective treatment for adolescents with certain disorders. Specifically, there is evidence of the effectiveness of concrete approaches of systemic family therapy on the symptoms of adolescents and family functioning in general. However, few studies have examined the effectiveness of other relevant approaches, such as structural and strategic family therapy, incorporating parent⁻child or parental dyadic measurement. The purpose of this study was to test the effectiveness of a structural⁻strategic family therapy with adolescents involved in mental health services and their families. For this purpose, 41 parents and adolescents who participated in this treatment were interviewed at pre-test and post-test, providing information on adolescent behavior problems, parental sense of competence, parental practices, parenting alliance, and family functioning. Regardless of participants' gender, adolescents exhibited fewer internalizing and externalizing problems after the treatment. Parents reported higher family cohesion, higher satisfaction and perceived efficacy as a parent, and healthier parental practices (less authoritarian and permissive practices, as well as more authoritative ones). An interaction effect between parenting alliance and gender was found, with more favorable results for the mothers. In conclusion, this paper provides evidence of the usefulness of structural⁻strategic family therapy for improving family, dyadic, and individual facets in families with adolescents exhibiting mental health problems.

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This article describes the use of emotion talk in the context of using a manualised approach to family therapy where the presenting problem is self-harm. Whilst we understand that there is an internal aspect to emotion, we also consider emotions to be socially purposeful, culturally constructed and interactional. We found that within the presenting families, negative emotions were often talked about as located within the young person. Through using 'emotion talk' (Fredman, 2004) in deconstructing and tracking emotions and exploring how emotions connected to family-of-origin and cultural contexts, we developed an interactional understanding of these emotions. This led to better emotional regulation within the family and offered alternative ways of relating. The article discusses the use of relational reflexivity, and using the therapist and team's emotions to enable the therapeutic process, encouraging reflexivity on the self of the therapist in relation to work with emotions. PRACTITIONER POINTS: Emotions can be seen as both a reflection of feelings experienced by the individual and as a communication.An interactional understanding of emotions can be used therapeutically.Therapists should explore emotional displays and track the interactional patterns within the therapeutic system.Therapists should self-reflexive about ways of doing emotions and use this awareness in practice.

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OBJECTIVE: The aim of this study was to find if systemic family therapy (SFT) does work in anxiety and depression with epilepsy in adolescents (ADAE). METHODS: 104 adolescents with epilepsy, aged 13-20 years old, were included from December 2009 to December 2010, the enrolled patients were with anxiety [Hamilton Anxiety Scale (HAMA) score ≥14 points] or depression [Hamilton Depression Scale (HAMD) score ≥20 points]. The patients were randomly divided into the control group (n=52) treated with antiepileptic drugs (AED) and the intervention group (n=52) undergone Systemic Family Therapy (SFT) as well as AED. The AED improvements, anxiety and depression scores, Social Support Rating Scale (SSRS), Family Assessment Device (FAD) and scale of systemic family dynamics (SSFD) were observed after 3-month treatment. RESULTS: The frequencies of epileptic seizures in intervention group was decreased much more significantly than the control group (4.22±3.54 times/month vs. 6.20±5.86 times/month, p=0.04); and the scores of anxiety (9.52±6.28 points vs. 13.48±8.47 points, p=0.01) and depression (13.86±9.17 points vs. 18.89±8.73 points, p=0.02) were significantly decreased than the control group; meanwhile, the family dynamics and family functions were significantly improved, and the social support was also increased (p<0.05). CONCLUSION: SFT combined with AEDs had better efficacies than AEDs alone, not only the frequency of epileptic seizures was decreased, but also the patients' anxiety and depression were improved, and the family dynamics, family functions and social support were improved.

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OBJECTIVE: The aim of this study was to find if systemic family therapy (SFT) does work in anxiety and depression with epilepsy in adolescents (ADAE). METHODS: 104 adolescents with epilepsy, aged 13-20 years old, were included from December 2009 to December 2010, the enrolled patients were with anxiety [Hamilton Anxiety Scale (HAMA) score ≥14 points] or depression [Hamilton Depression Scale (HAMD) score ≥20 points]. The patients were randomly divided into the control group (n=52) treated with antiepileptic drugs (AED) and the intervention group (n=52) undergone Systemic Family Therapy (SFT) as well as AED. The AED improvements, anxiety and depression scores, Social Support Rating Scale (SSRS), Family Assessment Device (FAD) and scale of systemic family dynamics (SSFD) were observed after 3-month treatment. RESULTS: The frequencies of epileptic seizures in intervention group was decreased much more significantly than the control group (4.22±3.54 times/month vs. 6.20±5.86 times/month, p=0.04); and the scores of anxiety (9.52±6.28 points vs. 13.48±8.47 points, p=0.01) and depression (13.86±9.17 points vs. 18.89±8.73 points, p=0.02) were significantly decreased than the control group; meanwhile, the family dynamics and family functions were significantly improved, and the social support was also increased (p<0.05). CONCLUSION: SFT combined with AEDs had better efficacies than AEDs alone, not only the frequency of epileptic seizures was decreased, but also the patients' anxiety and depression were improved, and the family dynamics, family functions and social support were improved.

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Sin duda alguna, un par de páginas se han de quedar cortas a la hora de desglosar un poco sobre aquellos enfoques direccionados hacia el ser humano, desde lo individual, hasta su interacción en grupo y sociedad. Aun así, el presente artículo permite dar una mirada estructural y básica de lo que conlleva a la mención del concepto de Terapia Familiar Sistémica, en éste caso desarrollada en contextos de pobreza, básicamente en América Latina, y más específicamente en Colombia. A través de una contextualización estructurada de términos, ubicados en la raíz del tema principal, se pretende hacer un recorrido que vaya desde lo más sencillo, hasta lo más elaborado, para finalmente impregnar al lector, de una forma más clara y globalizada, de la ubicación y el universo que se constituye alrededor de la Terapia Familiar Sistémica, en los contextos de pobreza; su constitución, fundamento e importancia en nuestra sociedad.

Anyway a couple of pages will be short when we want to drill down a bit on those directed towards the human being approaches from the individual to his group interaction and society. Even so, this article can give a structural and basic look of what it takes to mention the concept of Systemic Family Therapy, developed in contexts of poverty, mainly in Latin America and more specifically in Colombia. Through a structured contextualization of terms, located in the root of the main theme it is to make a journey that goes from the simplest to the most elaborated, and finally imbue the reader of a clearer and globalized form of the location and the universe that is around the Systemic Family Therapy in contexts of poverty; its constitution, foundation and importance in our society.

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A violência intrafamiliar precoce, crônica e recorrente pode levar ao desenvolvimento de transtornos mentais, incluindo o Transtorno de Estresse Pós- Traumático (TEPT) e o Trauma Complexo. Os efeitos da exposição à violência intrafamiliar comumente não são limitados à infância e à adolescência, podendo impactar o funcionamento psicológico, social e ocupacional na vida adulta. As intervenções com maior eficácia para esses casos envolvem psicoterapia individual (psicoterapia cognitivo-comportamental) e psicoterapia familiar (sistêmica e cognitivo-comportamental). Na abordagem cognitivo-comportamental-sistêmica, a técnica da linha de vida pode se caracterizar como uma estratégia útil na avaliação do curso temporal da exposição a eventos estressores, bem como das respostas adaptativas e desadaptativas dos diferentes membros do sistema familiar. O objetivo deste trabalho é apresentar um processo de psicoterapia familiar breve com o uso da técnica da linha de vida em uma família exposta a múltiplas situações de violência intrafamiliar como estratégia terapêutica.(AU)

Intrafamily violence when precocious, chronic and recurrent may lead to the development of mental disorders, including Posttraumatic Stress Disorder (PTSD) and Complex Trauma. The effects of exposure to intrafamily violence commonly are not limited to childhood and adolescence, and may impact psychological, social and occupational functioning in adulthood. The most effortful intervention to these cases involves individual psychotherapy (cognitive-behavioral psychotherapy) and family psychotherapy (systemic and cognitive-behavioral). In the cognitive-behavioral-systemic approach, the lifeline technique can be characterized as a useful strategy in the evaluation of the temporal course of the exposure to stressor events, as well as the adaptive and maladaptive answers from the members of the family system. The aim of this paper is to present a brief family psychotherapy process with a family exposed to multiple situations of intrafamily violence with the use of lifeline’s technique as a therapeutic approach.(AU)

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Intrafamily violence when precocious, chronic and recurrent may lead to the development of mental disorders, including Posttraumatic Stress Disorder (PTSD) and Complex Trauma. The effects of exposure to intrafamily violence commonly are not limited to childhood and adolescence, and may impact psychological, social and occupational functioning in adulthood. The most effortful intervention to these cases involves individual psychotherapy (cognitive-behavioral psychotherapy) and family psychotherapy (systemic and cognitive-behavioral). In the cognitive-behavioral-systemic approach, the lifeline technique can be characterized as a useful strategy in the evaluation of the temporal course of the exposure to stressor events, as well as the adaptive and maladaptive answers from the members of the family system. The aim of this paper is to present a brief family psychotherapy process with a family exposed to multiple situations of intrafamily violence with the use of lifeline’s technique as a therapeutic approach.(AU)

A violência intrafamiliar precoce, crônica e recorrente pode levar ao desenvolvimento de transtornos mentais, incluindo o Transtorno de Estresse Pós- Traumático (TEPT) e o Trauma Complexo. Os efeitos da exposição à violência intrafamiliar comumente não são limitados à infância e à adolescência, podendo impactar o funcionamento psicológico, social e ocupacional na vida adulta. As intervenções com maior eficácia para esses casos envolvem psicoterapia individual (psicoterapia cognitivo-comportamental) e psicoterapia familiar (sistêmica e cognitivo-comportamental). Na abordagem cognitivo-comportamental-sistêmica, a técnica da linha de vida pode se caracterizar como uma estratégia útil na avaliação do curso temporal da exposição a eventos estressores, bem como das respostas adaptativas e desadaptativas dos diferentes membros do sistema familiar. O objetivo deste trabalho é apresentar um processo de psicoterapia familiar breve com o uso da técnica da linha de vida em uma família exposta a múltiplas situações de violência intrafamiliar como estratégia terapêutica.(AU)

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A violência intrafamiliar precoce, crônica e recorrente pode levar ao desenvolvimento de transtornos mentais, incluindo o Transtorno de Estresse Pós- Traumático (TEPT) e o Trauma Complexo. Os efeitos da exposição à violência intrafamiliar comumente não são limitados à infância e à adolescência, podendo impactar o funcionamento psicológico, social e ocupacional na vida adulta. As intervenções com maior eficácia para esses casos envolvem psicoterapia individual (psicoterapia cognitivo-comportamental) e psicoterapia familiar (sistêmica e cognitivo-comportamental). Na abordagem cognitivo-comportamental-sistêmica, a técnica da linha de vida pode se caracterizar como uma estratégia útil na avaliação do curso temporal da exposição a eventos estressores, bem como das respostas adaptativas e desadaptativas dos diferentes membros do sistema familiar. O objetivo deste trabalho é apresentar um processo de psicoterapia familiar breve com o uso da técnica da linha de vida em uma família exposta a múltiplas situações de violência intrafamiliar como estratégia terapêutica.

Intrafamily violence when precocious, chronic and recurrent may lead to the development of mental disorders, including Posttraumatic Stress Disorder (PTSD) and Complex Trauma. The effects of exposure to intrafamily violence commonly are not limited to childhood and adolescence, and may impact psychological, social and occupational functioning in adulthood. The most effortful intervention to these cases involves individual psychotherapy (cognitive-behavioral psychotherapy) and family psychotherapy (systemic and cognitive-behavioral). In the cognitive-behavioral-systemic approach, the lifeline technique can be characterized as a useful strategy in the evaluation of the temporal course of the exposure to stressor events, as well as the adaptive and maladaptive answers from the members of the family system. The aim of this paper is to present a brief family psychotherapy process with a family exposed to multiple situations of intrafamily violence with the use of lifeline’s technique as a therapeutic approach.

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BACKGROUND: 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. OBJECTIVE: 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. DISCUSSION: 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). CONCLUSION: 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.

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