Brief Strategic Family Therapy is best articulated around three central constructs: system, structure/patterns of interactions, and strategy (Szapocznik & Kurtines, 1989
). A system is an organized whole that is comprised of parts that are interdependent or interrelated. A family is a system that is comprised of individuals whose behaviors necessarily affect other family members. In addition, family members become accustomed to the behavior of other family members, because such behaviors have occurred thousands of times over the many years. These behaviors synergistically work together to organize a family’s system.
A central characteristic of a system, per se, is that it is comprised of parts that interact with each other. The set of repetitive patterns of interactions that are idiosyncratic to a family is called the family’s structure, which is the second central construct. A maladaptive family structure is characterized by repetitive family interactions such that family members repeatedly elicit the same unsatisfactory responses from other family members. From a contextual family systems perspective, a maladaptive family structure is viewed as an important contributor to the occurrence and maintenance of behavior problems, drug abuse, and other antisocial behavior. Research demonstrates that family relations are predictors of drug abuse and related antisocial behaviors (cf. Szapocznik & Coatsworth, 1999
). Fortunately, research also suggests that adolescent drug abuse and behavior problems can change as a result of changes in the family relations (Liddle & Dakof, 1995b
; Santisteban et al., 2000
). Equally important, interventions aimed at changing family patterns of interaction represent a strategic point of entry. The goal of BSFT is to target repetitive interactions within or between systems in the family social ecology that are unsuccessful at achieving the goals of the family or its individual members. This emphasis on the nature of social interactions among family members is sometimes referred to as family process (Robbins et al., 1998
). Process also refers to the message that is communicated by the nature of interactions or by the style of communication, including all that is communicated nonverbally such as feelings, tone, and power relationship.
The third fundamental concept of BSFT is strategy, which is defined by interventions that are practical, problem-focused, and deliberate. Practical interventions are selected for their likelihood to move the family toward desired objectives. One important aspect of practical interventions is choosing to emphasize one aspect of a family’s reality (e.g., “that a drug abusing youth is in pain”) as a way to foster a parent-child connection, or another aspect (e.g., “this youth can get killed or overdose anytime”) as a way to heighten the sense of urgency. This positive or negative reframing is done in lieu of portraying the entire reality of a situation. Such a practical selective focus is done, in part, in an effort to create movement outside or beyond the family’s maladaptive patterns of interaction.
The problem-focused aspect of our treatment strategy refers to targeting family interaction patterns that are the most directly relevant to the symptomatic behavior targeted for change. Although the families that we treat usually have multiple problems, targeting only those patterns of interactions linked to the symptomatic behavior contributes to the brevity of the intervention. For example, a couple’s ability to parent is likely to be targeted because of its direct link to problem behaviors. However, the couple’s sexual problems in their marital relationship might not be targeted in this brief therapy model.
Our intervention strategies are very deliberate, meaning that the therapist determines the maladaptive interactions that, if changed, are most likely to lead to our desired outcomes (i.e., adaptive, prosocial behavior). The treatment intervention is designed to help the family shift from one set of interactions that maintain drug use (e.g., disengaged parent–child relationship) to another set of interactions that will reduce drug use (e.g., higher quality of parent–child interactions resulting in more effective monitoring of a youth’s behavior).
Thus, BSFT is based on developing a clear understanding of the nature of maladaptive family interactions and their relationship to the target symptom, which permits designing deliberate, problem-focused interventions. In sum, system, structure/interactions, and strategy are three basic constructs of family systems theory that serve as the foundation for BSFT. With this strong clinical and theoretical foundation, we pursued the systematic development of a measure that assesses family functioning according to underlying structural family theory, and can be used to evaluate structural family system changes targeted by BSFT.
Measure to Assess Structural Family Functioning
One important step to measuring family functioning was the development of the Structural Family Systems Ratings measure. This theoretically and clinically meaningful measure of structural family functioning represents one of the most important advances of our program of research (cf. Kazdin, 1993
). To launch our development of this observational measure, we borrowed from the work of Minuchin and his colleagues (Minuchin et al., 1978
) with the Wiltwyck Family Tasks as standard stimuli. Moreover, we standardized and manualized the administration procedure to enhance the reliability and replicability of the scoring procedure (Hervis, Szapocznik, Mitrani, Rios, & Kurtines, 1991
We operationalized the three core family systems concepts into the following five interrelated theoretically and clinically important dimensions (Robbins, Hervis, Mitrani, & Szapocznik, 2000
; Szapocznik & Kurtines, 1989
): (a) “Structure” measures leadership, subsystem organization, and communication flow; (b) “Resonance” measures the sensitivity of family members toward one another (focusing on boundaries and emotional distance between family members); (c) “Developmental Stage” measures the extent to which each family member’s roles and tasks are consistent with what would be expected given their age and family role; (d) “Identified Patienthood” measures the extent to which family members view the symptom bearer (e.g., adolescent drug abuser) as the cause of all of the family’s problems; and (e) “Conflict Resolution” identifies the family’s style in addressing disagreements through denial, avoidance, diffusion or expression and negotiation of differences of opinion. In a recent study (Robbins, Feaster, & Szapocznik, 2000
), we found that these five theoretically derived factors achieved a better fit than empirically derived latent constructs.
The psychometric properties of the instrument were examined in a series of construct validity studies conducted with 500 Hispanic clinic families (Szapocznik, Rio, Hervis et al., 1991
; NIDA Grants DA 2059, DA 5334, & NIMH Grant MH 34821). We found that the Structural Family Systems Ratings measure (a) is sensitive to improvements produced by BSFT (Santisteban et al., 1996
; Szapocznik, Santisteban et al., 1989
), (b) distinguishes interventions that bring about structural family change from those that have non-family foci (Santisteban et al., 2000
; Szapocznik, Rio et al., 1989
), and (c) is unobtrusive as evidenced by the nil effect of repeated administrations of the Wiltwyck task on family interactions (Szapocznik, Santisteban et al., 1989
The Structural Family Systems Ratings measure has become an essential tool for answering some of the critical questions posed by subsequent steps in our program of research. We have continued to refine the measure by attempting to apply its use to nonresearch, clinical settings (Szapocznik & Kurtines, 1989
). Currently, we are striving to adapt the measure to the range of family constellations that occur in contemporary society (e.g., single parent and extended kinships) with a variety of other target problems (e.g., families with a diabetic child, HIV + adults, caregivers of Alzheimer’s patients) and ethnic populations (e.g., African American and Hispanic). Developing a theoretically valid and psychometrically sound measure of structural concepts in family functioning permitted us to engage in research to evaluate the impact of BSFT on structural family functioning.
Empirical Testing of the Treatment Model
BSFT vs. Non-Family Interventions
Two clinical trials empirically compared BSFT with other modalities. The first compares structural family therapy/BSFT to individual psychodynamic child therapy for emotionally and behaviorally troubled children. The second compares BSFT and group counseling for adolescents with behavior problems.
The first study (Szapocznik, Rio et al., 1989
; NIMH Grant MH 34821) tested the relative efficacy/effectiveness of structural family therapy/BSFT and investigated the mechanisms of therapeutic change. In this study, structural family therapy/BSFT was compared to individual psychodynamic child-centered psychotherapy and a recreational control condition. Individual psychodynamic child therapy (Adams, 1974
; Cooper & Wanerman, 1977
) was chosen for comparison because, at the time of the study, a survey of Hispanic practitioners in private practice revealed that it was the treatment of choice for therapists who worked with emotionally and behaviorally troubled Hispanic children in the Miami area. The control condition was comprised of structured recreational activities; and this condition was used to control for attention placebo effects (McCardle & Murray, 1974
; Strupp & Hadley, 1979
Sixty-nine Hispanic moderately emotionally or behaviorally troubled 6 to 11 year old boys were randomly assigned to one of the three intervention conditions. For the two treatment conditions, Hispanic therapists were selected with at least 10 years of experience in their respective modality. Thus, rather than therapists receiving training in a modality as is typical in modern trials, these therapists were selected from the community to reflect best practices within their respective modalities as judged by their excellent reputation among their peers. Therapists’ treatment adherence was measured to evaluate the extent to which individual child psychodynamic and structural family/BSFT conditions were distinct interventions. To reflect clinical practice, a priori, the clinical and research teams had established that patterns of adherence should be 75% child psychodynamic, 25% BSFT for the child psychodynamic team; and 75% BSFT, 25% child psychodynamic for the BSFT team. That is, therapists in each treatment modality claimed interventions as unique to their own modality, that were also used occasionally (up to 25%) in the other modality. In the child psychodynamic condition, 78% of the therapists’ interventions were rated as child psychodynamic. In the structural family/BSFT condition, 61% of the interventions were rated as consistent with structural family/BSFT theory. While treatment adherence was found to sufficiently distinguish the two treatment modalities, the family therapists used more psychodynamic interventions than expected. Item analysis revealed that “psychodynamic” techniques used in the family condition were primarily supportive interventions or reflection of feelings, rather than more uniquely psychodynamic interventions.
Attrition data were analyzed using chi squares, and outcome data were analyzed using a mixed design Analysis of Variance. The results of the analyses revealed several important findings, the first three of which involved treatment outcome and the relative effectiveness of the conditions. The fourth conclusion concerned the articulation of mechanisms that may account for the specific effects of differential treatments. The first finding indicates that the control condition (i.e., recreation activities) was significantly less effective at retaining cases than the two treatment conditions, χ2 (2,19) = 13.64, p < .01), with over two thirds of all dropouts occurring in the control condition. These findings suggest that the two experimental treatment conditions had equivalent rates of retention, thus differences in treatment outcome between the treatment groups were most likely due to the treatment interventions. The second finding was that the two treatment conditions, structural family/BSFT and child psychodynamic, equivalently reduced emotional and behavior problems (parent and child reports) and child psychodynamic functioning. In addition, the effects of maturation or regression towards the mean (from significant behavior problems to fewer) were ruled out because the control condition did not evidence improvement in emotional, behavior, or psychodynamic functioning.
The third and most significant differential treatment finding was that family therapy was more effective than child therapy in protecting family integrity at the 1-year follow-up. Although individual psychodynamic child therapy was found to be efficacious at reducing behavior and emotional problems as well as improving child psychodynamic functioning, it was also found bring about deterioration of family functioning at the 1-year follow up. In contrast, the family therapy condition brought about significant improvement of family functioning at the one-year follow up. The fourth finding revealed that there is a complex relationship between specific mechanisms (family interaction vs. psychodynamic child functioning) that may mediate outcome. It seems that the mediator of change is a “corrective experience” in both the structural family/BSFT and child psychodynamic conditions. However, in psychodynamic child therapy, the therapist serves as the person who creates the corrective experience through the transference relationship. In contrast, the structural family/BSFT therapist changes family interactions so that the parent becomes the source of the corrective experience. The findings provided support for the structural family theory assumption that treating the whole family is important because it improves the symptoms and protects the family. In contrast, treating only the child appears to sufficiently treat the symptom, but neglects and increases risk for family functioning.
The second study (Santisteban et al., 2000
) examined the efficacy of BSFT in reducing behavior problems. In this study, BSFT was compared to a control condition delivered in a group format. The participants were 79 Hispanic client-families with a 12- to 18-year-old adolescent who was referred by either a school counselor or parent for conduct/anti-social problems or emotional problems, and family conflict. Client-families were randomly assigned to either BSFT (n
= 52) or group counseling (n
= 27). Adolescents in the BSFT condition showed significant reductions in Conduct Disorder and Socialized Aggression from pre- to post-treatment; whereas, group therapy participants showed no significant changes in either Conduct Disorder or Socialized Aggression, F
(2,76) = 4.75, p
An exploratory analysis of clinically significant changes in Conduct Disorder and Socialized Aggression using the twofold criterion recommended by Jacobson and Traux (1991)
, revealed that a substantially larger proportion of BSFT cases demonstrated clinically significant improvement. At intake, 39 of the 52 BSFT cases had Conduct Disorder scores that were above clinical cut-offs. At the end of treatment, 44% of the 39 made reliable improvement and 5% showed reliable deterioration. In contrast, only two (7%) of the group counseling cases with Conduct disorder showed reliable change; both showed clinically reliable deterioration in Conduct Disorder. With regard to Socialized Aggression, 81% of BSFT cases and 72% of group counseling cases were above clinical cut-offs at intake. Whereas 16 (38%) of BSFT cases showed reliable change, only 2 (11%) in the group counseling condition reliably changed. Seven (17%) BSFT cases recovered to nonclinical levels, while only one case (6%) from the group counseling condition recovered to nonclinical levels.
Together, these two studies provide some empirical support for the efficacy of BSFT with troubled Hispanic children and adolescents. The remainder of this article presents a broad range of BSFT adaptations, expanding its boundaries and applications.
Bicultural Effectiveness Training
One of the earliest efforts to expand the boundaries and applications of BSFT emerged from our realization that structural interventions could be enhanced by utilizing our specific knowledge about the culture of recent Hispanic immigrants (Szapocznik, Scopetta, & King, 1978
). Indeed, for this population, we found that the process of acculturation can profoundly disrupt the family unit as well as its individual members (Szapocznik, Scopetta, & King, 1978
; Szapocznik, Scopetta, Kurtines et al., 1978
). The usual intergenerational family discrepancies between parents and adolescents were exacerbated when combined with acculturation, creating considerable intercultural/intergenerational conflict processes (Szapocznik, Santisteban, Kurtines, Perez-Vidal, & Hervis, 1984
). The adolescent’s normal striving for independence combined with the powerful acculturation to the American value of individualism occurs in marked contrast to Hispanic parents’ normal tendency to preserve family integrity by tenacious adherence to the Hispanic cultural value of strong family cohesion and parental control. The combination of the intergenerational and cultural differences produce intensified conflict in which parents and adolescents feel alienated from each other.
As a result of our initial application of BSFT to recent immigrant Hispanic families, it became evident that the process of immigration and acculturation needed to be specifically addressed for a subset of families. Consequently, we developed Bicultural Effectiveness Training (Szapocznik et al., 1984
), a psychoeducational adaptation of BSFT principles. Bicultural Effectiveness Training aimed to ameliorate adolescent behavior problems and acculturation-related stresses confronted by two-generation Hispanic immigrant families.
Bicultural Effectiveness Training uses strategic, deliberate, and problem-focused psychoeducational interventions designed to change family interactions that are delivered to the conjoint family. A pervasive reframe in this intervention is to change the content of parent-adolescent conflict from one that is initially presented as intergenerational (i.e., parents vs. children) to one that is intercultural (i.e., Americanism vs. Hispanicism). Transcultural experiences that are perceived as stressful are reframed as being unique opportunities that can be potentially enriching for bicultural skills development. The outcome of Bicultural Effectiveness Training is that family members develop skills to more effectively cope with each other’s conflicting cultural values and behavioral expectations (Szapocznik & Kurtines, 1993
A clinical trial was conducted to compare the efficacy of the Bicultural Effectiveness Training and conventional BSFT (Szapocznik, Santisteban, Rio, Perez-Vidal, Kurtines, & Hervis, 1986
; NIMH Grant MH31226). Forty-one Cuban American families with a behavior problem adolescent were randomly assigned to either Bicultural Effectiveness Training or BSFT. Treatment integrity analyses revealed that interventions in both conditions adhered to guidelines, and that the two conditions were clearly distinguishable. Results showed that in both conditions there were significant improvement in adolescent problem behaviors and family functioning. These findings suggested that in families confronting acculturation both conditions, Bicultural Effectiveness Training (a culture-specific psychoeducational modality) and conventional BSFT (a process oriented intervention), were effective in achieving improvements in family interactions and adolescent problem behaviors.
In a subsequent study, we fully integrated BSFT with its psychoeducational version, Bicultural Effectiveness Training, into a package we called Family Effectiveness Training (Szapocznik, Santisteban, Rio, Perez-Vidal, & Kurtines, 1986
). Typically, sessions began with a didactic presentation followed by exercises to practice the strategies taught in the presentation. These enactments (Haley, 1976
; Minuchin, 1974
) served to provoke repetitive, maladaptive family interactions, which were subsequently targeted with BSFT interventions. We conducted another randomized clinical trial to test this newly integrated treatment modality by comparing Family Effectiveness Training to a Minimum Contact Control (Szapocznik, Santisteban et al., 1989
; NIDA Grant DA2694). This study examined 79 Hispanic families and their 6- to 11-year-old children who presented with emotional and behavior problem pre-adolescents. The results indicated that families in the Family Effectiveness Training condition showed significantly greater improvement than control families on structural family functioning, child behavior problems, and child self-concept. The expansion of BSFT for use alone or in combination with a culture-specific psychoeducational modality demonstrates the versatility of the BSFT approach. To further explore the versatility of BSFT, we challenged some of the underlying principles of family systems theory.
One Person Family Therapy
With the advent of the adolescent drug epidemic of the 1970s, the vast majority of counselors who worked with drug using youths reported that although they preferred to use family therapy, they were not able to bring whole families into treatment (Coleman, 1976
). In response, we developed a procedure that would achieve the goals of BSFT (changes in maladaptive family interactions and symptomatic adolescent behavior) without requiring the presence of the whole family in treatment sessions. For this purpose, we developed an adaptation of BSFT called One Person Family Therapy (Szapocznik, Foote, Perez-Vidal, Hervis, & Kurtines, 1985
; Szapocznik & Kurtines, 1989
; Szapocznik, Kurtines, Perez-Vidal, Hervis, & Foote, 1989
). This approach appears to challenge the most basic assumption of family systems theory: that change in family interactions is achieved by working directly with the conjoint family. One Person Family Therapy capitalizes on the systemic concept of complementarity, which suggests that when one family member changes, the rest of the system responds by either restoring the family process to its old ways or adapting to the new changes (Minuchin & Fishman, 1981
). The goal of One Person Family Therapy is to change the drug abusing adolescent’s participation in maladaptive family interactions that include him/her. Occasionally, these changes create a family crisis as the family attempts to return to its old ways. We use the opportunity created by these crises to engage reluctant family members.
A major clinical trial was conducted to compare the efficacy of One Person Family Therapy to conjoint BSFT (Szapocznik, Kurtines, Foote, Perez-Vidal, & Hervis, 1983
; NIDA Grant DA0322). An experimental design was achieved by randomly assigning 72 Hispanic families with a drug abusing 12- to 17-year-old adolescent to the One Person or Conjoint BSFT modalities. Both conditions were designed to use exactly the same BSFT theory, so that only one variable (one person vs. conjoint meetings) would differ between the conditions. Analyses of treatment integrity revealed that interventions in both conditions adhered to guidelines, and that the two conditions were clearly distinguishable. The results showed that One Person was as efficacious as conjoint BSFT in significantly reducing youth drug use and behavior problems as well as improving family functioning (Szapocznik, Kurtines et al., 1983
). When we juxtaposed these findings with the findings of our research cited earlier (Szapocznik, Rio et al., 1989
), we came to the following conclusion: It appears that an individual modality conceptualized in family terms, can bring about improvements in family functioning; whereas an individual modality conceptualized in individual terms can result in deterioration of family functioning.
Structural Strategic Systems Engagement
Many families that seek treatment for drug abusing adolescents are not engaged in therapy. In response to this problem, we developed a set of procedures based on BSFT principles to more effectively engage behavior problem, drug abusing youths and their families in treatment. This approach, which we called Strategic Structural Systems Engagement (Szapocznik & Kurtines, 1989
; Szapocznik, Perez-Vidal, Hervis, Brickman, & Kurtines, 1989
), is based on the premise that resistance to enter treatment can be understood in family interactional terms. We have suggested elsewhere (Szapocznik & Kurtines, 1989
) that the family interactional patterns linked to symptomatic behavior in the adolescent are essentially the same patterns that prevent the family from entering treatment. Thus, while the presenting symptom may be drug abuse, the initial obstacle to change is “resistance” to attending treatment. If “resistance” to therapy lies within maladaptive family interactions, then the first phase of therapy is engagement intervention targeting these interactions (Szapocznik, Perez-Vidal et al., 1989
One Person Family Therapy techniques are useful in this initial phase because the person making the contact requesting help becomes the “one person” through whom work is initially done to restructure the maladaptive family interactions that are maintaining the symptom of resistance. Success of the engagement process is measured by the family’s and the symptomatic youth’s attendance to family therapy. In part, success in engagement permits redefining the problem focus as a family problem in which all have something to gain. Once the family is engaged into treatment, the focus of the intervention is shifted from engagement to removal of the adolescent’s presenting symptoms of problem behavior and drug abuse. A significant paradigm shift in this kind of thinking is that family’s resistance to entering treatment is overcome by changing the therapist’s behavior (Santisteban & Szapocznik, 1994
). That is, therapists have to begin therapy with the first phone call (Szapocznik, 1993
) and therapists must reach out to the family by assisting the family in its natural setting to overcome the maladaptive patterns of interaction that obstruct the family from entering therapy.
The efficacy of Strategic Structural Systems Engagement has been tested twice with Hispanic youths (Santisteban et al., 1996
; Szapocznik et al., 1988
). The first study (Szapocznik et al., 1988
; NIDA Grant DA2059) included 108 mostly Cuban Hispanic families of behavior problem adolescents who were suspected of, or were observed using drugs by their parents or school counselors. Of those engaged, 93% actually reported drug use. Families were randomly assigned to one of two conditions: Engagement as Usual, the control condition; or Strategic Structural Systems Engagement, the experimental condition. All families successfully engaged received BSFT. A community survey was used to determine the nature of the engagement strategies typically used in outpatient agencies serving drug abusing adolescents. The Engagement as Usual condition resembled the usual engagement methods identified. In the experimental condition, client-families were engaged using BSFT techniques developed specifically to overcome the family patterns of interactions that interfered with entry into treatment. Successful engagement was defined as the conjoint family (minimally the identified patient and her/his parents and siblings living in the same household) attending the first session, which was usually for the intake assessment. Treatment integrity analyses revealed that interventions in both engagement conditions adhered to prescribed guidelines using six levels of engagement effort that were operationally defined; and that the conditions were clearly distinguishable by level of engagement effort applied.
Efficacy was measured in rates of both, family treatment entry as well as retention to treatment completion. The results revealed that 42% of the families in the Engagement as Usual condition and 93% of the families in the Structural Systems Engagement condition were successfully engaged, χ2 (1,108) = 29.64, p < .0001. Of the engaged cases, 25% (of the 52) in the Engagement as Usual condition and 77% (of the 56) in the Structural Systems Engagement condition were successfully terminated, χ2 (1,108) = 26.93, p < .0001. In families that engaged, significant improvements occurred in adolescent and family functioning for both conditions, and these improvements were not significantly different across the conditions. Thus, the critical distinction between the conditions was in their differential rates of engagement and retention.
The second study (Santisteban et al., 1996
; NIDA Grant DA0 3224), in addition to replicating the previous engagement study, also explored factors that might moderate the efficacy of the engagement interventions. In contrast to the previous engagement study, Santisteban et al. 1996
more stringently defined the success of engagement as a minimum of two office visits, intake session and
first therapy session. One hundred ninety three Hispanic families were randomly assigned to one experimental and two control conditions. The experimental condition was BSFT plus Strategic Structural Systems Engagement. The first control condition was BSFT plus Engagement as Usual; and the second was group counseling plus Engagement as Usual. In both control conditions, Engagement as Usual involved no specialized engagement strategies.
Results showed that 81% of families (42 of 52) were successfully engaged in the BSFT plus Strategic Structural Systems Engagement experimental condition. In contrast, 60% (84 of 141) of the families in the two control conditions were successfully engaged, χ2
= 193) = 7.5, p
< .006. However, the efficacy of the experimental condition procedures was moderated by the type of Hispanic cultural/ethnic identity. Among non-Cuban Hispanics (composed primarily of Nicaraguan, Colombian, Puerto Rican, Peruvian, and Mexican families) assigned to the Strategic Structural Systems Engagement condition, the rate of engagement was 93%, in contrast to an engagement rate of 64% for Cuban Hispanics. These findings have led to further study of the mechanism by which culture/ethnicity and other contextual factors may influence clinical processes related to engagement (Santisteban et al., 1996
; Santisteban, Muir-Malcolm, Mitrani, & Szapocznik, in press
). The result of these studies provide strong support for the efficacy of Structural Systems Engagement. The result of the second study supports the widely held belief that therapeutic interventions must be responsive to the constantly evolving population-contextual conditions (Santisteban et al., in press
; Sue, Zane, & Young, 1994
; Szapocznik & Kurtines, 1993
Summary of Completed Research
We have reviewed seven major completed randomized trials (see ) funded either by the NIMH or NIDA. The first two studies reviewed (Santisteban et al., 2000
; Szapocznik Rio et al., 1989
) found BSFT to be superior to an alternative intervention. In the first case, BSFT was superior in bringing about improved family functioning when compared to child psychodynamic therapy. In the second case, BSFT was superior in bringing about improved adolescent and family functioning when compared to a group counseling intervention.
Comparison of BSFT-based Interventions
We developed Strategic Structural Systems Engagement as an application of BSFT to the problem of engaging drug abusing, behavior problem adolescents and their families into treatment. In two randomized trials (Santisteban et al., 1996
; Szapocznik et al., 1988
) we demonstrated the superiority of this application of BSFT in engaging drug abusing, behavior problem Hispanic adolescents and their families into BSFT treatment. This work has contributed to a paradigm shift that received considerable support from Henggeler and colleagues (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998
), which is that resistance to treatment is reflective of maladaptive family processes, and engagement begins at first contact.
In three additional studies we showed the versatility of BSFT. In one of these (Szapocznik, Santisteban, Rio, Perez-Vidal, Kurtines et al., 1986
) we developed a culture specific psychoeducational adaptation, and found it to be as effective as conventional BSFT. In the second (Szapocznik, Santisteban, Rio, Perez-Vidal, Kurtines et al., 1989
), we combined the psychoeducational intervention with conventional BSFT and found the combined modality to be superior to a minimum contact control. Finally, in the third study, we developed a One Person version of BSFT that was as efficacious as conjoint BSFT at reducing adolescent problem behaviors and improving family functioning.
Our most recent adaptation of BSFT has been to widen its focus from intrafamilial interactions to the social interactions in the immediate social environment. The next section reviews our current efforts at testing the social–ecological adaptation of BSFT theory and its applications. Four major randomized studies are underway testing these new adaptations, two of which target adolescents and are described below.