Multidimensional Family Therapy: Evidence Base for Transdiagnostic Treatment Outcomes, Change Mechanisms, and Implementation in Community Settings

• Author: Howard A. Liddle
• DOI: http://doi.org/10.1111/famp.12243
• Published date: 01 September 2016
• Date: 01 September 2016

Multidimensional Family Therapy: Evidence Base for

Transdiagnostic Treatment Outcomes, Change

Mechanisms, and Implementation in Community

Settings

HOWARD A. LIDDLE*

This article summarizes the 30+-year evidence base of Multidimensional Family Therapy

(MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors.

Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness ran-

domized controlled trials, therapy process studies, cost analyses, and implementation trials.

This research has evaluated various versions of MDFT. These studies have systematically

tested adaptations of MDFT for diverse treatment settings in different care sectors (mental

health, substance abuse, juvenile justice, and child welfare), as well as adaptations according

to treatment delivery features and client impairment level, including adolescents presenting

with multiple psychiatric diagnoses. Many published scientific reviews, including meta-ana-

lyses, national and international government publications, and evidence-based treatment reg-

istries, offer consistent conclusions about the clinical effectiveness of MDFT compared with

standard services as well as active treatments. The diverse and continuing MDFT research,

the favorable, multi-source independent evaluations, combined with the documented receptiv-

ity of youth, parents, community-based clinicians and administrators, and national and

international MDFT training programs (U.S.-based organization is MDFT International,

www.mdft.org; and Europe-based organization is www.mdft.nl) all support the potentia l for

continued transfer of MDFT to real-world clinical settings.

Keywords: Treatment Outcomes; Multidimensional Family Therapy; Treatment Process;

Change Mechanisms; Implementation Research

Fam Proc 55:558–576, 2016

*Departments of Public Health Sciences and Psychology, Center for Treatment Research on Adolescent Drug

Abuse, University of Miami Miller School of Medicine, Miami, FL.

Correspondence concerning this article should be addressed to Howard Liddle, University of Miami

Miller School of Medicine, Clinical Research Building (CRB) #1042, 1140 NW, 12th Avenue, Miami, FL

33136. E-mail: hliddle@miami.edu

Howard A. Liddle receives financial compensation for his role as consultant and member of the Board of

Directors of MDFT International, a 501(c) (3) public charity dedicated to the implementation of MDFT.

The research reported in this article was supported by grants from the National Institutes of Health

(AA016186-01A2, DA027216, DA29089, DA026126, DA 016733, DA15412, DA016193, DA13298-01A1,

DA07697, DA11328, DA09424, DA15995, DA13089, DA016969, DA017478, DA0186345), Substance Abuse

and Mental Health Services Administration (TI11871), and the Federal Ministries of Health of Belgium,

Germany, the Netherlands, Switzerland, and MILDT: the Mission Interministerielle de Lutte Contra la

Drogue et de Toximanie, France. Finally, I thank the hundreds of colleagues who have contributed might-

ily to MDFT research over the years and offer special recognition to my multi-decade collaborators Gayle

Dakof, Ph.D., Cindy Rowe, Ph.D., Henk Rigter, Ph.D. and Craig Henderson, Ph.D.

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Family Process, Vol. 55, No. 3, 2016 ©2016 Family Process Institute

doi: 10.1111/famp.12243

INTRODUCTION

This article summarizes the evidence base of Multidimensional Family Therapy (MDFT),

a comprehensive, family-centered treatment for youth substance abuse and antisocial

behaviors (Liddle,1991, 2002, 2016). The theoretical and clinical roots of MDFT lie in devel-

opmental-contextual and dynamic systems frameworks, family and developmental psychol-

ogy, and family therapy (Liddle, 2004). Commencing and continuing since 1985 with NIH

funding, the MDFT research program is diversified, integrated, and reflective of treatment

development frameworks in the psychotherapy and substance abuse fields (Liddle & Hogue,

2001). Four types of studieshave been conducted—efficacy/effectiveness randomizedclinical

trials (RCTs), therapy process studies, cost analyses, and implementation/dissemination

studies. Supporting the model’s effectiveness with a wide range of clinically referred youth,

numerous community-based MDFT randomized controlled trials have been critically evalu-

ated in over a dozen independent scientific reviews and national and international evi-

dence-based treatment registries. Treatment outcomes are consistent across a variety of

high-quality RCTs. These studies have tested different adaptions of MDFT in diverse set-

tings, with varied youth populations and clinical characteristics, assessing different out-

come domains. Clinical outcomes remain stable at follow-up, connect to the targeting of

well-specified and theory-related risk and protective factors, including individual, family,

and systemic processes outside of the family (SAMHSA,2008). In sum, multiple sources and

criteria characterize MDFT studies as scientifically rigorous, evidencing transdiagnostic

outcomes, and reflective of a practical, flexible, adaptive,and widely transportable approach

(California Evidence Based Clearinghouse, 2010; Child Trends, 2016; Drug & Alcohol Find-

ings 2002, 2009; Drug Strategies, 2003, 2005; EMCDDA, 2014; National Institute of Justice,

2012; NIDA, 1999, 2006; OJJDP, 1999; Perepletchikova, Krystal, & Kaufman, 2008).

Overview of Treatment Principles

Family functioning is instrumental in creating new, developmentally adaptive lifestyle

alternatives for adolescents. Current behaviors within and across settings offer an accessi-

ble and immediate handle on problems that warrant clinical referral. Given this multicon-

textuality, intra-individual, interpersonal, and intersystem interactions are all relevant in

case conceptualization, which consists of making practical, process-oriented sense of

family members’ lives and circumstances. Change is multifaceted, and different kinds and

degrees of change are possible, and so interventions are individualized per the family’s

and individual family members’, and relevant others’ expectations, and ongoing response

to treatment. Therapists must learn about the complexities of human motivation, under-

standing its multidimensionality (emotion, cognitive, behavioral, contextual aspects), its

malleability, and its influence throughout treatment. Treatment focus and methods are

organized according to three different stages (Dakof, Cohen, et al., 2010; Dakof, Godley, &

Smith, 2010). A clinician’s preparation for clinical work is fundamental to treatment out-

come. A therapeutic attitude is optimistic about change, strengths focused, energetic , and

shows itself in how the therapist establishes multiple therapeutic alliances with family

members and involved professionals outside of the family (Liddle, Dakof, & Diamond,

1991; Liddle, Dakof, Henderson & Rowe, 2011).

Manuals and Other Supporting Materials

The MDFT treatment manual is available online

1

, and a new version is forthcoming

(Liddle, in press). A certification procedure includes site readiness preparation, clinical

1

Treatment manual (Liddle, 2002) used in t he Cannabis Youth Treatment Study: http://lib.adai.wa shing-

ton.edu/clearinghouse/downloads/Multidimensional-Family-Therapy-for-Adolescent-Cannabis-Users-207.pdf.

Fam. Proc., Vol. 55, September, 2016

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