Brief Strategic Family Therapy

Mental Health Substance Use Prevention or Treatment In-home Parent Skill-Based Well Supported

Brief Strategic Family Therapy (BSFT) uses a structured family systems approach to treat families with children or adolescents (6 to 17 years) who display or are at risk for developing problem behaviors including substance abuse, conduct problems, and delinquency. There are three intervention components. First, counselors establish relationships with family members to better understand and ‘join’ the family system. Second, counselors observe how family members behave with one another in order to identify interactional patterns that are associated with problematic youth behavior. Third, counselors work in the present, using reframes, assigning tasks and coaching family members to try new ways of relating to one another to promote more effective and adaptive family interactions. BSFT is typically delivered in 12 to 16 weekly sessions in community centers, clinics, health agencies, or homes. BSFT counselors are required to participate in four phases of training and are expected to have training and/or experience with basic clinical skills common to many behavioral interventions and family systems theory.


Brief Strategic Family Therapy is rated as a well-supported practice because at least two studies with non-overlapping samples carried out in usual care or practice settings achieved a rating of moderate or high on design and execution and demonstrated favorable effects in a target outcome domain. At least one of the studies demonstrated a sustained favorable effect of at least 12 months beyond the end of treatment on at least one target outcome.


Date Research Evidence Last Reviewed: Mar 2020


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, the program or service manual, and the studies reviewed.

 

Program/Service Description Updated: Week of August 24, 2020


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

BSFT is designed for families with children or adolescents (6 to 17 years) who display or are at risk for developing problem behaviors including: drug use and dependency, antisocial peer associations, bullying, or truancy.

Dosage

BSFT is typically delivered in 12 to 16 weekly sessions, depending on individual and family needs.

Location/Delivery Setting
Recommended Locations/Delivery Settings

BSFT can be delivered in a variety of settings such as community centers, clinics, health agencies, and homes.

Location/Delivery Settings Observed in the Research

  • Home
  • Mental Health Center, Treatment Center, Therapist Office
  • School
  • Hospital/Medical Center

Education, Certifications and Training

BSFT is delivered by trained therapists, typically with at least a master’s degrees in social work, marriage and family therapy, psychology or a related field. Therapists are expected to have training and/or experience with basic clinical skills common to many behavioral interventions and family systems theory.

BSFT training consists of live workshops that address especially complex clinical dilemmas and allow time for therapists to practice essential skills. The workshops are a combination of didactics, practice exercises and videotape analysis of BSFT family sessions. They also include clinical case consultations and live family sessions if desired. BSFT training also consists of a supervision practicum that begins 1-2 weeks after the initial workshop and continues for 4-6 months depending on trainee advancement. This supervision practicum entails weekly phone reviews of the trainees’ electronically recorded BSFT family therapy sessions, along with group feedback and consultation.

Sites that wish to offer BSFT are initially required to demonstrate readiness for integrating the BSFT program into their organization. To that end, a Site Readiness process is implemented prior to training. After sites successfully complete training and meet competency and fidelity requirements, they are then licensed. Both the Brief Strategic Family Therapy Institute and the Family Therapy Training Institute of Miami license sites.

Program or Service Documentation
Book/Manual/Available documentation used for review

Szapocznik, J. Hervis, O., & Schwartz, S. (2003). Brief Strategic Family Therapy for adolescent drug abuse (NIH Pub. No. 03-4751). National Institute on Drug Abuse.

Available languages

Materials for BSFT are available in English and Spanish.

Contact Information for Developers

Brief Strategic Family Therapy® Institute

(305) 243-7585 

bsft@med.miami.edu

http://www.bsft.org/

 

Family Therapy Training Institute of Miami

(305) 859-2121

info@bsft-av.com

https://brief-strategic-family-therapy.com/

Results of Search and Review Number of Studies Identified and Reviewed for Brief Strategic Family Therapy
Identified in Search 6
Eligible for Review 5
Rated High 1
Rated Moderate 1
Rated Low 3
Reviewed Only for Risk of Harm 0
Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings
Child well-being: Behavioral and emotional functioning -0.06
-2
1 (5) 327 Favorable: 1
No Effect: 3
Unfavorable: 1
Child well-being: Substance use -0.05
-2
1 (17) 420 Favorable: 0
No Effect: 17
Unfavorable: 0
Child well-being: Delinquent behavior 0.31
12
1 (4) 261 Favorable: 4
No Effect: 0
Unfavorable: 0
Adult well-being: Parent/caregiver substance use 0.00
0
1 (2) 480 Favorable: 1
No Effect: 1
Unfavorable: 0
Adult well-being: Family functioning 0.06
2
2 (8) 455 Favorable: 1
No Effect: 7
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.

Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Child well-being: Behavioral and emotional functioning -0.06
-2
1 (5) 327 Favorable: 1
No Effect: 3
Unfavorable: 1
-
Horigian, 2013
Diagnostic Interview Schedule for Children-Predictive Scales: Anxiety (Child Report) -0.09
-3
- 315 - 4
Diagnostic Interview Schedule for Children-Predictive Scales: Anxiety (Parent Report) -0.38 *
-14
- 327 - 4
Diagnostic Interview Schedule for Children-Predictive Scales: Depression (Child Report) -0.02
0
- 315 - 4
Diagnostic Interview Schedule for Children-Predictive Scales: Anxiety (Parent Report) -0.10
-4
- 327 - 4
Horigian, 2015
Adult Self Report: Externalizing Behaviors 0.30 *
11
- 261 - 50
Child well-being: Substance use -0.05
-2
1 (17) 420 Favorable: 0
No Effect: 17
Unfavorable: 0
-
Horigian, 2015
Timeline Follow-Back: Mean Drug Use Days 0.05
2
- 261 - 50
Robbins, 2011
Timeline Follow-Back: Drug Use Days (Month 1) Null
not calculated
- 420 - 0
Timeline Follow-Back: Drug Use Days (Month 2) Null
not calculated
- 403 - 0
Timeline Follow-Back: Drug Use Days (Month 4) Null
not calculated
- 373 - 0
Timeline Follow-Back: Drug Use Days (Month 5) Null
not calculated
- 362 - 0
Timeline Follow-Back: Drug Use Days (Month 6) Null
not calculated
- 357 - 0
Timeline Follow-Back: Drug Use Days (Month 7) Null
not calculated
- 335 - 0
Timeline Follow-Back: Drug Use Days (Month 8) Null
not calculated
- 335 - 0
Timeline Follow-Back: Drug Use Days (Month 9) Null
not calculated
- 326 - 1
Timeline Follow-Back: Drug Use Days (Month 10) Null
not calculated
- 325 - 2
Timeline Follow-Back: Drug Use Days (Month 12) Null
not calculated
- 311 - 4
Positive Urine Test for Drug Use (Month 1) -0.01
0
- 371 - 0
Positive Urine Test for Drug Use (Month 6) -0.21
-8
- 296 - 0
Positive Urine Test for Drug Use (Month 7) -0.25
-10
- 282 - 0
Positive Urine Test for Drug Use (Month 8) -0.27
-10
- 284 - 0
Positive Urine Test for Drug Use (Month 9) -0.20
-7
- 286 - 1
Positive Urine Test for Drug Use (Month 11) -0.04
-1
- 254 - 3
Child well-being: Delinquent behavior 0.31
12
1 (4) 261 Favorable: 4
No Effect: 0
Unfavorable: 0
-
Horigian, 2015
Number of Arrests in Lifetime 0.34 *
13
- 261 - 50
Number of Arrests in Past Year 0.26 *
10
- 261 - 50
Number of Incarcerations in Lifetime 0.33 *
13
- 261 - 50
Number of Incarcerations in Past Year 0.29 *
11
- 261 - 50
Adult well-being: Parent/caregiver substance use 0.00
0
1 (2) 480 Favorable: 1
No Effect: 1
Unfavorable: 0
-
Horigian, 2015b
Addiction Severity Index-Lite: Alcohol Use Favorable *
not calculated
- 480 - 4
Addiction Severity Index-Lite: Alcohol and Drug Use Null
not calculated
- 480 - 4
Adult well-being: Family functioning 0.06
2
2 (8) 455 Favorable: 1
No Effect: 7
Unfavorable: 0
-
Robbins, 2011
Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Parent Report) -0.06
-2
- 382 - 0
Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Parent Report) 0.06
2
- 333 - 0
Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Parent Report) 0.21
8
- 327 - 4
Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Child Report) 0.01
0
- 375 - 0
Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Child Report) 0.03
1
- 331 - 0
Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Child Report) 0.02
0
- 318 - 4
Santisteban, 2003
Family Environment Scale: Conflict (Adolescent Reported) -0.34
-13
- 73 - 0
Structural Family Systems Rating: Total Score 0.70 *
25
- 52 - 0

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers.

Studies Rated High

Study 10570

Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., . . . Szapocznik, J. (2011). Brief Strategic Family Therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713-727.

Horigian, V. E., Weems, C. F., Robbins, M. S., Feaster, D. J., Ucha, J., Miller, M., & Werstlein, R. (2013). Reductions in anxiety and depression symptoms in youth receiving substance use treatment. The American Journal On Addictions, 22(4), 329-337. doi:10.1111/j.1521-0391.2013.12031.x

Horigian, V. E., Feaster, D. J., Robbins, M. S., Brincks, A. M., Ucha, J., Rohrbaugh, M. J., . . . Szapocznik, J. (2015). A cross-sectional assessment of the long term effects of Brief Strategic Family Therapy for adolescent substance use. The American Journal On Addictions, 24(7), 637-645. doi:10.1111/ajad.12278

Horigian, V. E., Feaster, D. J., Brincks, A., Robbins, M. S., Perez, M. A., & Szapocznik, J. (2015). The effects of Brief Strategic Family Therapy (BSFT) on parent substance use and the association between parent and adolescent substance use. Addictive Behaviors, 42, 44-50. doi:10.1016/j.addbeh.2014.10.024

Robbins, M. S., Szapocznik, J., Horigian, V. E., Feaster, D. J., Puccinelli, M., Jacobs, P., . . . Brigham, G. (2009). Brief Strategic Family Therapy for adolescent drug abusers: A multi-site effectiveness study. Contemporary Clinical Trials, 30(3), 269-278. doi:10.1016/j.cct.2009.01.004

Feaster, D. J., Robbins, M. S., Horigian, V., & Szapocznik, J. (2004). Statistical issues in multisite effectiveness trials: The case of Brief Strategic Family Therapy for adolescent drug abuse treatment. Clinical Trials, 1(5), 428-439.

Horigian, V. E., Robbins, M. S., Dominguez, R., Ucha, J., & Rosa, C. L. (2010). Principles for defining adverse events in behavioral intervention research: Lessons from a family-focused adolescent drug abuse trial. Clinical Trials, 7(1), 58-68. doi:10.1177/1740774509356575

Robbins, M. S., Feaster, D. J., Horigian, V. E., Puccinelli, M. J., Henderson, C., & Szapocznik, J. (2011). Therapist adherence in Brief Strategic Family Therapy for adolescent drug abusers. Journal of Consulting and Clinical Psychology, 79(1), 43-53.


Studies Rated Moderate

Study 10573

Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W. M., Schwartz, S. J., LaPerriere, A., & Szapocznik, J. (2003). Efficacy of Brief Strategic Family Therapy in modifying hispanic adolescent behavior problems and substance use. Journal Of Family Psychology, 17(1), 121-133.


Studies Rated Low

Study 10571

Nickel, M., Luley, J., Krawczyk, J., Nickel, C., Widermann, C., Lahmann, C., . . . Loew, T. (2006). Bullying girls - changes after Brief Strategic Family Therapy: A randomized, prospective, controlled trial with one-year follow-up. Psychotherapy And Psychosomatics, 75(1), 47-55.

This study received a low rating because the standards for addressing missing data were not met.
Study 10572

Nickel, M. K., Muehlbacher, M., Kaplan, P., Krawczyk, J., Buschmann, W., Kettler, C., . . . Nickel, C. (2006). Influence of family therapy on bullying behaviour, cortisol secretion, anger, and quality of life in bullying male adolescents: A randomized, prospective, controlled study. Canadian Journal Of Psychiatry, 51(6), 355-362.

This study received a low rating because the standards for addressing missing data were not met.
Study 10569

Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief Strategic Family Therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313-332.

This study received a low rating because it did not meet design confound standards.


Studies Not Eligible for Review

Study 10574

Valdez, A., Cepeda, A., Parrish, D., Horowitz, R., & Kaplan, C. (2013). An adapted Brief Strategic Family Therapy for gang-affiliated Mexican American adolescents. Research on Social Work Practice, 23(4), 383-396. 

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6)