Demand-withdraw interaction is a pattern of communication in which one person demands change from another who withdraws. In the treatment domain, evidence of parallel demand-withdraw processes comes from a study of couple therapy for alcoholic men, where wife-demand/husband-withdraw interaction predicted poor response to a high-demand intervention (Shoham et al., 1998). The current study extends this parallel-process idea to family therapy for substance-using adolescents by examining whether adolescents entrenched in parent-demand/adolescent-withdraw interaction are less likely to engage in treatment and more likely to use drugs post-treatment when counselors pressure them to change.
Participants were 91 families who received ≥ 4 sessions of Brief Strategic Family Therapy (BSFT; Szapocznik et al., 2003) in a multi-site clinical trial on adolescent drug abuse and an additional non-engagement sample of 21 families who completed ≤ 2 sessions. Before randomization, families completed videotaped family interaction tasks from which trained observers coded parent-demand/adolescent-withdraw. Another team of raters coded therapists’ demands during an early and (for most cases) a later BSFT session, while a third team rated quality of BSFT. The main dependent variable was a composite index of adolescent substance use based on monthly self-reports and urine drug screens over 12 months.
A matched-sample examination of sessions attended (≤ 2 vs. ≥ 4) revealed no effect of early-session therapist demand on engagement. However, multi-level models partially supported the main hypothesis: adolescents high in parent-demand/adolescent withdraw who received high-quality BSFT from relatively non-demanding therapists used fewer drugs during and after treatment than other adolescent participants. Furthermore, as therapist demand on high PD/AW adolescents increased, youth substance use also increased.
Results suggest that attending to parallel demand-withdraw processes in parent/adolescent and therapist/adolescent dyads may be useful in family therapy for substance-using adolescents. Replicating ineffective parent behavior within the therapeutic system may undermine the prospect of decreased adolescent drug use outcomes.
|Advisor:||Shoham, Varda, Rohrbaugh, Michael J.|
|Commitee:||Butler, Emily A., Sbarra, David A.|
|School:||The University of Arizona|
|School Location:||United States -- Arizona|
|Source:||DAI-B 71/11, Dissertation Abstracts International|
|Keywords:||Abuse, Adolescent, Demand-withdraw, Drug, Drug abuse, Family, Family therapy, Therapy|
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