If you have a teen with substance abuse issues or participating in criminal activities, multidimensional family therapy (MDFT) is an integral part of the intervention process. Teens with substance abuse issues or who are acting out against authority are in a delicate emotional state and need the support of not only their medical team, but all members of the family as well.
Multidimensional family therapy is designed specifically for teens in crisis. Whether your teen is dealing with alcohol and drug addiction or criminal behavior, multidimensional family therapy is a proven, scientifically studied method of intervention.
When you are considering an intervention for your teen, no matter the circumstances, the treatment plan will likely include some form of family therapy. If you are thinking about multidimensional family therapy, there are several factors you need to look for: the best practices in MDFT, experience of the therapist, and availability of long-term care.
Defining Multidimensional Family Therapy
MDFT can be best defined by examining the treatment objectives. The principle treatment objectives are to eliminate substance abuse, get control of behavioral issues that include criminal activity, to enhance mental health, increase focus on education, and improve family dynamics. MDFT develops the teen’s coping skills, problem-solving proficiency, and decision-making abilities. The treatment also improves family functioning, which is essential for positive development in the effected teen.
The program is successful because it concentrates on known factors that drive teen problems. Interventions are cooperative with the teen, members of the family, and trained professionals. Treatment stresses compassion and respect among all participants.
Multidimensional family therapy fosters positive change within the heart and mind of the teen, gives parents new skills to relate to their teen, helps the family solve problems, encourages outward signs of love and affection among family members, and modifies the family’s interactions with the teen’s school, local authorities, and their community.
There are multiple fundamental treatment objectives in MDFT:
Treatment Engagement and Completion – In many teen treatment programs, dropout rates are high. Multidimensional family therapy engages teens and their families. This helps to motivate them to not only enter treatment, but to complete treatment.
Family Functioning – MDFT improves family functioning by avoiding fault finding and blame. It is not possible to access the healing power of families if blame and fault are constantly present. The individual and family sessions work to bring the family to an understanding of the issues and how they can work together to solve problems.
Substance Abuse – Multidimensional family therapy utilizes multiple approaches, including teen-focused individual therapy sessions and random drug testing; this helps teens to focus on their drug use and addiction. Substance abuse treatment is far more effective when the family and therapist present the teen with irrefutable evidence. Once the teen cannot deny the abuse, a treatment program can be designed that is family-oriented, age appropriate, and provided by certified MDFT professionals.
Academic Performance – Parents and teens are taught how to reconnect with the teen’s school teachers and administrators to schedule productive meetings. The teen needs to reintegrate to the school environment without conflict, with an action plan in place in case of conflict, and what steps the teen can take to remain a productive member of the school community. The collaborative effort is about getting positive outcomes in behavior and academic work. MDFT therapists develop an ongoing relationship with schools to troubleshoot problems and readjust interventions as needed.
Criminal and Delinquent Behavior – Multidimensional family therapy encourages positive alternatives to antisocial and criminal behavior. The healthcare team works with representatives of the juvenile justice system to support the teen and coordinate interventions as needed.
Family Stability – When MDFT works, the relationships between teens and their parents are strengthened and the family works together to find new ways to solve problems both inside and outside of the family environment.
Mental Health Symptoms – Multidimensional family therapy “reduces stress, depression, and anxiety by teaching adolescents new skills, and helping them see life in a new perspective with a fresh set of eyes.”
Treatment settings and lengths will vary depending on the facility where the family is seeking treatment. Multidimensional Family Therapy has been implemented in various mental health care and treatment centers. MDFT is available in multiple institutions:
- Rehab centers including outpatient, intensive outpatient, day programs, and residential treatment facilities such as our own
- Among teens in juvenile justice, drug court, and child welfare settings
- As a culturally-responsive and gender-sensitive approach across cultures and countries
- As an early intervention or preventative approach for teens
- In urban and rural settings
There are hundreds of MDFT programs available across the United States. Check with your local health care provider for a recommended facility that is certified in MDFT best practices.
MDFT Best Practices
When it is time to bring your family into the MDFT arena, it is important to understand what the underlying best practices are for the technique. Best practices in multidimensional family therapy start with the treatment principles:
- Teen problems are not singular – they are multidimensional
- MDFT addresses the individual, family, and environmental factors
- Family functioning is instrumental in creating lasting change
- It is the therapist’s job to create the conditions that motivate teens and parents
- Therapists create individual working relationships with each participant and consulting medical professionals
- Individualized interventions harness strengths to encourage teen developmental
- Therapist attitude and skill are fundamental to success
When the family is engaged in working within these principles, they are ready to move through the stages of treatment:
Stage 1: Build a foundation for change
Therapists must create an environment where the teen, parents, and siblings feel validated and respected. Therapists meet with the teen alone, with the parents as a couple, or with the family as a whole, depending on the goals of that day’s therapy session. During Stage 1, relationships and trust must be built along with establishing shared developmental and motivational goals that include individual reflection and self-examination.
Stage 2: Facilitate individual and family change
Goals for the teen, parent, and family functioning are created, assessed, and reexamined throughout this phase. “Accomplishments in each individual domain activate and support change in the others.”
Stage 3: Solidify changes
During the last few weeks of treatment, the teen and parents review the successes and accomplishments they have achieved. The therapist expands changes and helps families create concrete plans for responding to future problems such as relapse, family arguments, or further incidents. The family reflects on the changes made during treatment, see a brighter future, and gain hope.
In addition, the treatment considers four different domains to work within:
ADOLESCENT DOMAIN
- Improve self-awareness, self-worth, and confidence
- Develop significant short-term and long-term goals
- Improve emotional control, coping skills, and problem-solving abilities
- Improve communication skills
- Foster success in school/work
- Encourage positive peer interactions and activities
- Reduce substance use, delinquency, and troubling behaviors
- Improve and stabilize mental health issues
PARENT DOMAIN
- Strengthen parental teamwork – create a united front
- Improve parenting skills and practices
- Rebuild parent-teen emotional connections
- Enhance parents’ individual functioning
FAMILY DOMAIN
- Improve family communication and problem-solving approaches
- Strengthen emotional attachments and feelings of love among family members
- Improve everyday functioning of the family
COMMUNITY DOMAIN
- Improve family members’ relationships with social systems
- Build family member capacity to access and obtain requisite resources
These best practices are what certified MDFT therapists train for and use in treating families. Without these credentials, they cannot use the MDFT methods.
Therapist Credentials
Trained therapists conduct therapy sessions with the teen and family at a suitable intensity and time period to suit the family’s needs. Sessions can be one, two, or three times each week, and usually take place for 16 to 24 weeks, though some programs are as short as 12 weeks. Therapists don’t work individually; they work with a team, including a therapist assistant who delivers community interventions.
Therapists who wish to use MDFT must have a master’s degree in social work, counseling, marriage and family therapy, or another related clinical field. Therapist certification requires the study of written and video material, exercises, and review feedback:
- Onsite 2.5-3 Day Introduction to the method of MDFT
- 12-15 Weekly Team Consultation Calls with certified therapists as a guide
- Written assessment 1
- Two Onsite Intensives (Video Review and Live Supervision for each therapist & instruction on the MDFT Clinical Portal)
- Written assessment 2
Therapists must re-certify annually. They must complete all therapist recertification requirements between 9 and 12 months after their previous certification or recertification date. Once a therapist is re-certified, the therapist can continue to work on MDFT cases.
Therapists must also meet quality assurance requirements to maintain their certification.
- Onsite Booster Training: Video Review and Live Supervision for each therapist, Video Review of Supervision, Consultation on Therapist Development Plans (TDP) and overall program implementation.
- Therapist competency and adherence evaluations
- Review, Rating, & Feedback on Supervision Session video for each supervisor
- 3 Consultation calls with Supervisor and/or Team throughout the year
- Bi-annual reviews of Therapist Development Plans (TDPs)
- Bi-annual reviews of MDFT Clinical Portal Reports
Once you are certain the program you have selected is properly certified, it’s time to begin multidimensional family therapy. The program is effective, but what about long-term care for your teen and the family?
Aftercare
While most residential and outpatient multidimensional family therapy programs are very successful, the approach does lack an aftercare component. That means that once the teen and the family successfully complete the 12 to 24 week program, they will be referred to a family therapist or other mental health professional for aftercare.
Based on your teen’s needs, your family therapist may recommend individual therapy, group therapy (with peers), and family therapy. Reaching the end of the MDFT treatment program is not the end of your family’s journey. MDFT gives your teen and family the tools to recognize substance abuse signs, behavioral problems, and signs of mental health issues.
After the program, it is essential that the entire family participate in maintaining a healthy, cooperative environment in the home to help prevent any relapses in your affected teen.
The mental health care team can recommend varying lengths of aftercare, depending on the teen’s needs and outlook upon completion of multidimensional family therapy. It is essential that the patient follow the aftercare plan carefully, as substance abuse relapse rates can be 40 to 60 percent, according to the National Institute on Drug Abuse. Teens are encouraged to work with a 12-step program. If the teen has been engaging in criminal activity, 12-step program participation can be ordered by the court. The teen needs to keep all outpatient follow-up appointments with their mental health care team.
And any good aftercare treatment program should include the following components:
- Relapse prevention strategy drawn up and rehearsed
- Prescription for consistent participation in addiction support / self-help groups (frequent attendance at 12-step meetings such as Alcoholics Anonymous or Narcotics Anonymous)
- Regularly scheduled outpatient follow-up appointments with a therapist or counselor for uninterrupted therapy
- As needed, arrangements for a controlled living environment after treatment – a sober living house, a halfway house, etc.
- Recommended or required random drug testing
- Monitoring: can be done during scheduled appointments, on the phone, or by email. The information age has given us a variety of innovative methods for continued patient care, including video appointments, text message check-ins, and other support and tracking apps.
It is also critical for your teen to find a supportive environment to continually assist them in keeping away from temptation. Everyone in the support system must remove any mind-altering substances from the teen’s environments, avoid using intoxicating substances in front of the recovering teen, and encouraging the teen to comply with the aftercare plan.
Successful aftercare programs will always include sponsors or accountability partners who are always available to talk. Particularly with multidimensional family therapy, an aftercare program must involve the entire family, peer group therapy, and individual therapy to ensure the teen’s continued recovery.
Conclusion
Multidimensional family therapy is a tiered, component based treatment plan that involves not only the effected teen, but the entire family. All members of the immediate family must participate if the teen is going to be successful in completing their rehabilitation and reintegration.