Therapist Strategies for Managing Midtreatment Problems in Evidence-based Interventions in Community Settings.

Area of Science:

• Implementation Science
• Clinical Psychology
• Family Therapy Research

Background:

• The National Institute of Health prioritizes developing effective intervention dissemination and implementation strategies.
• Multisystemic Therapy (MST) and Functional Family Therapy (FFT) are widely used evidence-based family treatments for adolescents.
• Midtreatment implementation problems can pose significant threats to the success of these interventions.

Purpose of the Study:

• To examine qualitative reports of therapist strategies for managing midtreatment implementation problems in MST and FFT.
• To identify contextual obstacles and therapist-reported strategies associated with treatment successes and failures.
• To compare strategies used in successful versus unsuccessful treatment cases.

Main Methods:

• Qualitative analysis of experienced therapists' reports on serious midtreatment problems.
• Examination of 16 treatment failures and 16 treatment successes, including reasons for termination and outcome ratings.
• Identification of contextual obstacles and therapist-implemented strategies in both successful and unsuccessful cases.

Main Results:

• Therapists frequently encountered midtreatment problems embedded within additional difficulties.
• Multiple relationship and process-focused strategies were employed to resolve these problems.
• Obstacles and strategies were often described similarly for successful and unsuccessful cases.

Conclusions:

• Therapists in successful MST and FFT cases may be more likely to report adherence to "on-script" strategies.
• Therapists in unsuccessful cases may report more "off-script" strategies, generic relationship building, and advice-giving.
• Understanding these patterns can inform training and support for effective intervention implementation.