James F. Alexander

Adolescent and Parent Therapeutic Alliances as Predictors of Dropout in Multidimensional Family Therapy

The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response.

Alliance and dropout in family therapy for adolescents with behavior problems: individual and systemic effects.

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent and adolescent) and family levels (within-family differences). Participants were 34 families who received functional family therapy for the treatment of adolescent (aged 12-18 years) behavior problems. Families were classified as treatment dropouts (n=14) or completers (n=20). Videotapes of the first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that individual parent and adolescent alliances did not predict retention. However, as hypothesized, dropout cases had significantly higher unbalanced alliances (parent minus adolescent) than did completer cases. These findings highlight the importance of alliances in functional family therapy and suggest that how the alliance operates in conjoint family therapy may be a function of systemic rather than of individual processes.

Generalizing treatment effects of functional family therapy: Three replications

Abstract Functional Family Therapy with status delinquents has undergone careful scrutiny in well designed studies that included random assignment, realistic comparison treatment programs, formally trained therapists, and reasonable follow-up periods. The current report describes three replications in which FFT has been extended to new populations, has utilized less formally trained therapists, and has been applied in new treatment contexts. Taken together the replications provide important support for the generalizability of FFT across client and therapist populations.

What does the cook and medley hostility scale measure ? affect, behavior, and attributions in the marital context

The Cook and Medley (1954) Hostility (Ho) scale has been used in several important studies evaluating potential health consequences of hostility. A relative lack of compelling information about the construct validity of the Ho scale, however, has raised concerns about the appropriate interpretation of previous research. In this study, 60 married couples discussed a low conflict topic, a high conflict topic, and then a second low conflict topic. High Ho men responded to the high conflict topic with significant increases in self-reported anger and anxiety and overt hostile behavior, but low Ho men did not. Furthermore, compared to low Ho men, high Ho men blamed their wives more for their usual disagreements on the high conflict topic and saw their disagreement-engendering behavior as more intentional. Among women, Ho scores were weakly related only to overt hostile behavior. Finally, couples consisting of two low Ho persons displayed a uniquely agreeable interactional style.

Family-Based Empirically Supported Interventions

In this article, the authors evaluate family-based counseling interventions from the perspective of the Principles of Empirically Supported Interventions (PESI). At the broadest level of evidence, both the qualitative and meta-analytic reviews provide substantial support for the general efficacy of family-based interventions. At more specific levels of evidence, family-based intervention programs that target at-risk adolescents demonstrate clinical success with a variety of clients and problems, in many locales, when delivered by a range of interventionists. Finally, the authors provide some thoughts on the current state of family-based intervention research and the value of the PESI criteria for identifying and developing effective treatments, as well as guiding future family-based research.

Family-Based Interventions with Older, At-Risk Youth: From Promise to Proof to Practice

The paper reviews a group of family-based interventions, which have received strong empirical support, with respect to intervention with older and more seriously at-risk youth. With such family-focused interventions it is not uncommon for the risk factors experienced by youth who already express clear behavioral problems to exist also for their siblings who may not yet show any of the negative behavior patterns, but nonetheless may be at high risk. Thus, a “treatment” program that effectively changes the ongoing maladaptive family processes surrounding the already dysfunctional youth will at the same time be changing the risk factors for the siblings who is not yet behaving problematically. As such, the program will simultaneously represent a treatment and a primary prevention program.

Observational coding in family therapy process research.

Observationally based coding systems represent one major source of information regarding the process of family therapy, the nature of change mechanisms, and the necessary components of intervention manuals. In this article, the authors introduce a two-dimensional framework for organizing the diverse approaches to observational coding that currently exist. These dimensions focus on the information used in identifying the coding unit and the degree of inference involved in assigning a code (i.e., meaning) to that unit. The goal in developing this framework is to provide a common basis on which observationally based family therapy process research initiatives can be developed, compared, and integrated.

Adolescent and Parent Alliances With Therapists in Brief Strategic Family TherapyTM With Drug‐Using Hispanic Adolescents

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.

Evolution of functional family therapy as an evidence-based practice for adolescents with disruptive behavior problems

This article summarizes the evolution of functional family therapy (FFT) based upon four decades of clinical practice and scientific scrutiny through research evidence. FFT research has evolved from an initial focus upon clinical process research, which examined sequential exchanges between therapists and family members. A key element of this research has been an examination of the way in which clinicians acquire, consolidate, and maintain the skills needed to implement FFT effectively with youth and families. Many randomized efficacy and effectiveness studies have evaluated the impact of FFT across diverse clinical populations. Subsequent research investigated factors that influence the effectiveness of implementation across more than 300 clinical settings in which more than 2,500 trained clinicians have provided service to nearly 400,000 families. Another important set of investigations concerned the cost-effectiveness of the interventions.

Type A Behavior and Marital Interaction: Hostile-Dominant Responses During Conflict

Previous research has indicated that the risk conferred by mens Type A versus B behavior depends, in part, on the personality characteristics of their spouses. In the present study of 60 married couples, we found that couples consisting of two Structured Interview-defined Type As showed a larger increase in hostile/dominant behavior during discussions of marital conflicts than did couples consisting of two Type Bs or a Type A husband and a Type B wife. Couples consisting of a Type B husband and a Type A wife displayed an intermediate level of hostile dominance. These results are consistent with previous speculations about interpersonal dynamics in Type A behavior and interaction patterns which might underlie spouse effects on Type A behavior and coronary risk.