Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

• Published date: 01 June 2019
• Author: Florencia Lebensohn‐Chialvo,Michael J. Rohrbaugh,Brant P. Hasler
• Date: 01 June 2019
• DOI: http://doi.org/10.1111/famp.12366

Fidelity Failures in Brief Strategic Family Therapy for

Adolescent Drug Abuse: A Clinical Analysis

FLORENCIA LEBENSOHN-CHIALVO*

MICHAEL J. ROHRBAUGH

†,‡

BRANT P. HASLER

‡,§

As evidence-based family treatments for adolescent substance use and conduct probl ems

gain traction, cutting edge research moves beyond randomized efficacy trials to addres s

questions such as how these treatments work and how best to disseminate them to commu-

nity settings. A key factor in effective dissemination is treatment fidelity, which refers to

implementing an intervention in a manner consistent with an established manual. While

most fidelity research is quantitative, this study offers a qualitative clinical anal ysis of

fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy

(BSFT) for adolescent drug abuse, where BSFT developers trained community therapi sts

to administer this intervention in their own agencies. Using case notes and video recor d-

ings of therapy sessions, an independent expert panel first rated 103 cases on quantitative

fidelity scales grounded in the BSFT manual and the broader structural-strategic frame-

work that informs BSFT intervention. Because fidelity was generally low , the panel

reviewed all cases qualitatively to identify emergent types or categories of fidelity failure.

Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to

engage key family members, failure to think in threes) and commissions (e.g., off-mod el,

nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared

basic and particularly problematic, reflecting the central place of this idea in structural

theory and therapy. Although subject to possible bias, our observations highlight likely

stumbling blocks in exporting a complex family treatment like BSFT to community set-

tings. These findings also underscore the importance of treatment fidelity in family therapy

research.

Keywords: Treatment Fidelity; Family Therapy; Adolesce nt Drug Abuse

Fam Proc 58:305–317, 2019

As evidence-based family treatments for adolescent substance use and conduct prob-

lems gain traction, cutting edge research moves beyond randomized efficacy trials to

address questions such as how these treatments work and how best to disseminate them

into community settings. Dozens of studies now document positive effects of family

*Department of Counseling and Marital and Family Therapy, University of San Diego, San Diego, CA.

†

Department of Psychology, University of Arizona, Tucson, AZ.

‡

Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC.

§

Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.

Correspondence concerning this article should be addressed to Florencia Lebensohn-Chialvo,

Department of Counseling & Marital and Family Therapy, University of San Diego, San Diego, CA 92110.

E-mail: flebensohn@sandiego.edu.

This research was supported in part by grant R01 DA17539 from the National Institute on Drug Abuse

(NIDA). Principal Investigator Varda Shoham died in March 2014.

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Family Process, Vol. 58, No. 2, 2019 ©2018 Family Process Institute

doi: 10.1111/famp.12366