Dissertation/Thesis Abstract

Demand-withdraw interaction in family therapy for adolescent drug abuse
by Rynes, Kristina N., Ph.D., The University of Arizona, 2010, 155; 3423835
Abstract (Summary)

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.

Indexing (document details)
Advisor: Shoham, Varda, Rohrbaugh, Michael J.
Commitee: Butler, Emily A., Sbarra, David A.
School: The University of Arizona
Department: Psychology
School Location: United States -- Arizona
Source: DAI-B 71/11, Dissertation Abstracts International
Subjects: Clinical psychology
Keywords: Abuse, Adolescent, Demand-withdraw, Drug, Drug abuse, Family, Family therapy, Therapy
Publication Number: 3423835
ISBN: 978-1-124-25032-8
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