Alliance and adherence in a systemic therapy

Contains fulltext : 175795.pdf (publisher's version ) (Open Access)Background: The client-therapist working alliance is a key contributor to effective adult psychotherapy. However, little is known about its role in family and systemic therapy. Moreover, few studies have assessed alliance longitudinally or have investigated how it interrelates with other process variables, such as therapist adherence (i.e. the extent to which the therapist adheres to the treatment protocol or manual). We hypothesised that alliance and adherence interrelate over the course of the therapy. Method: This study investigated the bidirectional associations between alliance and therapist adherence using cross-lagged panel analyses for a sample of 1970 adolescents and their families participating in Multisystemic Therapy (MST). A number of client characteristics were included as moderators, namely demographic characteristics, type and severity of adolescent problem behaviour, and whether or not the MST treatment was court ordered. Alliance and adherence were scored by the primary caregiver through telephone interviews at monthly intervals during treatment. Results: Alliance in 1 month predicted therapist adherence in a subsequent month. Adherence only predicted subsequent alliance during the middle part of the treatment process. The results were not moderated by any of the client factors. Conclusions: The results suggest that alliance and therapist adherence may reinforce one another during therapy. Although alliance may facilitate the development of therapist adherence, adherence may subsequently deepen and consolidate the client-therapist alliance. These results are independent of client characteristics.7 p

Alliance between therapist and multi-stressed families during the COVID-19 pandemic: The effect of family-based videoconferencing

Background: A strong therapeutic alliance or working relationship is essential for effective face-to-face family-based psychotherapy. However, little is known about the use of VC on alliance in family-based therapy. The recent COVID-19 pandemic led to a national lockdown during which most family-based therapy transferred to VC. Objective: The current study analyzed the development and strength of alliance prior and during lockdown for multi-stressed families participating in Multisystemic Therapy (MST). Method: Alliance with the therapist was reported monthly by 846 caregivers (81% female). Using latent growth curve models (longitudinal approach), the development of alliance was estimated for families participating in MST prior to the lockdown, transferring to VC early in treatment or late in treatment. Using regression analyses (cross-sectional approach), lockdown (yes/no) was included as predictor of alliance. In these analyses, type of family (regular; intellectual disability; concerns regarding child abuse or neglect) and gender of caregiver were included as moderators. Results: Both analytical approaches showed that alliance was not affected by VC, except for families with concerns of child abuse, who reported lower alliances during lockdown. However, these results where no longer significant when controlling for multiple testing. Conclusions: Strong alliances can be developed and maintained during family-based VC sessions with multi-stressed families. However, for some subgroups, such as families with concerns of child abuse, VC might not be suitable or sufficient. Future research needs to investigate the potential and limitations of using VC with families

Factorial structure of the Therapist Adherence Measure-Revised (TAM-R) within multisystemic therapy

Item does not contain fulltextThe Therapist Adherence Measure (TAM-R) is a central assessment within the quality-assurance system of Multisystemic Therapy (MST). Studies into the validity and reliability of the TAM in the US have found varying numbers of latent factors. The current study aimed to reexamine its factor structure using two independent samples of families participating in MST in the Netherlands. The factor structure was explored using an Exploratory Factor Analysis (EFA) in Sample 1 (N = 580). This resulted in a two-factor solution. The factors were labeled "therapist adherence" and "client–therapist alliance". Four cross-loading items were dropped. Reliability of the resulting factors was good. This two-factor model showed good model fit in a subsequent Confirmatory Factor Analysis (CFA) in Sample 2 (N = 723). The current finding of an alliance component corroborates previous studies and fits with the focus of the MST treatment model on creating engagement.5 p

Functionele Gezinstherapie en Multi Systeem Therapie: Een onderzoek naar de stabiliteit van doelgroepen en behandelresultaten in Nederland

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Treatment outcomes of a shortened secure residential stay combined with multisystemic therapy: A pilot study

Item does not contain fulltextThuisBest is a newly developed family focused treatment that combines secure residential youth care with multisystemic therapy (MST), allowing adolescents to return home after secure residential youth care more quickly. The purpose of this pilot study was to examine treatment outcomes for adolescents in ThuisBest (n = 86, Mage = 15.2 years, 63% boys) and to what degree those treatment outcomes could be predicted by client characteristics. The results showed that externalizing behavior problems and parenting stress had decreased at the end of treatment. After ThuisBest, 83% of the adolescents did not have new police contact, 72% lived at home, and 89% attended school or work. Almost none of the treatment outcomes could be predicted by any of the client characteristics. ThuisBest seems a promising trajectory, as it reduces the length of the stay in secure residential youth care, and may, therefore, be more cost-effective than standard secure residential youth care. However, given the lack of a control-group and follow-up data, findings must be interpreted as preliminary.18 p

Development of therapist adherence in relation to treatment outcomes of adolescents with behavioral problems

Therapist adherence to the treatment manual is assumed to be crucial for adequate implementation and subsequent achievement of the intended, positive treatment outcomes. Although adherence has been mostly studied as a static factor, recent studies suggest that adherence might be dynamic and changes over time. We investigated how parent-perceived adherence to the multisystemic therapy (MST) model develops during treatment and how this development is related to treatment outcomes up to 18 months posttreatment, controlling for the effect of alliance. We used routinely collected data from 848 adolescents (66% male and 76% Western, M age = 15.25 years) and their caregivers participating in MST, a family- and community-based intervention for antisocial adolescents. Adherence and alliance were measured monthly through phone interviews with the caregivers using the Therapist Adherence Measure-Revised. Outcomes were assessed at the end of the treatment and at 18 months posttreatment using the scale Rule-Breaking Behavior of the Child Behavior Checklist and two MST Ultimate Outcomes (i.e., police contact and out-of-home placement). On average, adherence showed an increasing and then flattening slope. The initial level of adherence predicted treatment outcomes at the end of treatment but not at 18 months posttreatment. Change in adherence did not predict treatment outcomes after controlling for alliance. We advocate the need to consider the dynamic nature of adherence in research as well as clinical practice. Change in adherence during treatment, as well as its association with outcome, is likely to be dependent on the adherence measure being used

Brief report: Follow-up outcomes of multisystemic therapy for adolescents with an intellectual disability and the relation with parental intellectual disability

Contains fulltext : 217707.pdf (publisher's version ) (Open Access)Research on follow-up outcomes of systemic interventions for family members with an intellectual disability is scarce. In this study, short-term and long-term follow-up outcomes of multisystemic therapy for adolescents with antisocial or delinquent behaviour and an intellectual disability (MST-ID) are reported. In addition, the role of parental intellectual disability was examined. Outcomes of 55 families who had received MST-ID were assessed at the end of treatment and at 6-month, 12-month and 18-month follow-up. Parental intellectual disability was used as a predictor of treatment outcomes. Missing data were handled using multiple imputation. Rule-breaking behaviour of adolescents declined during treatment and stabilized until 18 months post-treatment. The presence or absence of parental intellectual disability did not predict treatment outcomes. This study was the first to report long-term outcomes of MST-ID. The intervention achieved similar results in families with and without parents with an intellectual disability.7 p

The lack of cross-national equivalence of a therapist adherence measure (TAM-R) in multisystemic therapy (MST)

This two-study report investigates the equivalence of the Dutch Therapist Adherence Measure Revised (TAM-R) to the US original. The TAM-R is a questionnaire measuring therapist adherence to the treatment model of Multisystemic Therapy (MST). Monitoring of therapist adherence is essential for evidence-based interventions to ensure the quality of the delivered treatment. International implementation of the TAM-R assumes cross-national equivalence, even though this assumption has never been investigated. In study 1 Rasch analysis was applied to 1,875 Dutch TAM-R reports and the response category frequency distributions of the items of 1,875 US TAM-R reports. Response frequencies were more heavily skewed in the US compared to the Netherlands and several items showed Differential Item Functioning (DIF). Study 2 investigated whether adaptations to the translation of the items and response categories could improve equivalence. For this purpose, 237 families were randomly allocated to 1 of 3 versions (original TAM-R, adapted items only, adapted items and response categories) and the analyses from study 1 were replicated. Results indicated that equivalence was not improved by the adapted translations. The article concludes with a discussion of several potential other sources of bias, such as differences in sample characteristics, implementation of MST, and response styles

Residential youth care combined with systemic interventions: Exploring relationships between family-centered care and outcomes

Contains fulltext : 229453.pdf (publisher's version ) (Open Access)Family-centered care, in terms of parental involvement and family-centered staff attitude and behavior during placement in secure residential youth care, is increasingly being combined with systemic interventions. Little is known, however, about this combination of family-centered residential care and systemic interventions. This study assessed whether levels of parental involvement or family-centered staff attitude and behavior during placement predicted outcomes of systemic interventions. We first assessed the outcomes in the full sample of families receiving systemic interventions and thereafter in families receiving systemic interventions with a strong evidence base (Multidimensional Family Therapy, Multisystemic Therapy [specializing in treatment of individuals with an intellectual disability/with problem sexual behavior], Relational Family Therapy [MDFT, MST(-ID/-PSB), RGT]) and systemic interventions with a less strong evidence base (Attachment Based Family Therapy, Flexible Assertive Community Treatment [FACT], FamilyFACT, Forensic Ambulant Systemic Therapy, Systemic Therapy [ABFT, (Family)FACT, FAST, ST]). Results revealed that higher levels of parental involvement predicted less family empowerment and a longer duration of the systemic intervention. Higher levels of family-centered staff attitude and behavior predicted more parental distress, a shorter duration of the residential placement and a shorter duration of the systemic intervention. Combinations of secure residential youth care with different systemic interventions of different evidence bases resulted in different outcomes. Future research is needed to establish which components of family-centered care or systemic interventions contribute to adolescent outcomes.23 p