Treatment adherence and differentiation in individual versus family therapy for adolescent substance abuse

Treatment adherence and differentiation in dynamic cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse were evaluated with a treatment adherence process measure. Full-length videotapes of 90 treatment sessions (36 clients) were reviewed by nonparticipant raters. Adherence scales for each treatment generated through factor analysis of observational ratings demonstrated sound interrater reliability and internal consistency. Therapists in each condition used techniques unique to their own model and avoided those unique to the competing model. Individual therapists emphasized behavioral and substance-use interventions, whereas family therapists focused on interactional and affective interventions. Challenges in conducting adherence research that compares individual and family treatments are addressed, as are implications of these results for advancing treatment development for adolescent drug users.