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Multidimensional Family Therapy

Emerging from a federally funded research program tasked with evaluating and developing treatments for adolescents engaged in substance abuse, the Multidimensional Family Therapy (MDFT) is a family-based therapy designed to prevent and treat teen drug abuse and associated behavioral problems. Over the course of many studies, the approach MDFT takes has been recognized as a comprehensive drug abuse treatment program whose success can be attributed to its multidimensional approach that attacks the issue from multiple angles to reduce dysfunction, promote adaptive strategies and processes, and encourage appropriate social and developmental growth in adolescents.

The primary goals of the treatment program is to minimize or eliminate the substance abuse problem and associated deleterious conduct as well as improve overall functioning in the family and move the teen from a drug abuse lifestyle into one that is normative and supportive. Assessment and intervention is done simultaneously and the therapist generally seeks to improve the adolescent’s functioning in several core areas including parent-child relations, peer relations, formation of a healthy identity, and forming positive connections with social institutions such as school.

For the parents, the therapists works with them to address issues such as preventing parental abdication by increasing investment and commitment to the family, improving parent-child communication, and enhance parenting skills; all of which serve to better the relationship between the parent and child.

The MDFT model of juvenile substance abuse treatment has been used in a number of community and clinical settings consisting of ethnically and linguistically diverse at-risk youths and their families. Although the parents in the studies featuring MDFT came from a variety of economic and educational backgrounds, most of them lived in disadvantaged urban communities. The male and female adolescents treated using Multidimensional Family Therapy are a diverse group that includes young kids, teens with multiple behavioral issues, and those going through the juvenile justice system.

Several modifications have been made to the MDFT program to make it work within the clinical needs of different groups of people. An example of this is a version of the program designed to provide intense therapy for 16 to 25 sessions over a period of four to six months to address more challenging drug abuse and/or behavioral issues. Another example is a milder version of the program that consists of 12 sessions spread out over three months for teens that may only need subtle course corrections. The sessions may be conducted in a clinical setting, the home, community settings like a school, or over the telephone. These flexible options allow therapists to better respond to the needs of the target community.

Although the core content and focus of MDFT assessment and intervention model remains the same, the elements of individual sessions may change according to the needs of the patients. For example, the therapist may focus on concerns regarding the child’s development one day and their peer relations another day. Overall, there are three treatment stages that all patients go through:

  • Stage One: Foundation
  • Stage Two: Work
  • Stage Three: Set the changes and exit

Additionally, there are five models of assessment and intervention that may be applied at different point in the therapy:

  • Adolescent Intervention
  • Parental Intervention
  • Changes to interactions between parent and child
  • Interventions with family members
  • Interventions with external system

Multidimensional Family Therapy is a multi-system program that focuses on the adolescent’s development and hones in on the known risk factors associated with drug abuse and delinquency. It also works to enhance elements that protect the child from deleterious social influences and promotes healthy adolescent and family development.


MDFT has been the subject of several studies including two that are still ongoing. In one study, the efficacy of the program was compared to two others: Multifamily Educational Intervention and Adolescent Group Therapy. The group participants consisted of 95 youths who were known drug users and their families. They were assessed at the start of treatment and then again one year later for drug usage, detrimental behaviors, family relationships, and performance at school. Out of all the programs, participants who were treating using MDFT had the highest and most diverse amount of positive outcomes. Decreases in drug abuse and improvement in social and other beneficial areas such as family functioning and school performance remained stable long after the one year follow up assessment.

A North Philadelphia study involving 224 youths and their families focused on determining how MDFT compared to Cognitive-Behavioral Therapy (CBT) in the treatment of drug use and abuse. At intake, the drug use and symptoms of the patient and family were recorded and then again when treatment ended. At six and twelve months, the patients were interviewed again. While both treatments were effective at decreasing drug use and associated behavioral issues, the adolescents and families who went through the MDFT treatment continued to improve long after the termination of the therapy. At the twelve month mark, approximately 70 percent of MDFT patients were still abstinent compared to 55 percent of patients who when through CBT.

Multidimensional Family Therapy was included in the Cannibis Youth Treatment (CSAT) study. This was a multisite trial that included five treatments that were all eventually found to be effective at treating troubled drug abusing youths. However, MDFT was found to effective and affordable. Six months after the study ended, about 42 percent of youths who went through MDFT were not using drugs and did not display any associated behavioral consequences. The cost of the program was $164 per week, whereas other programs charged between $267 and $365 per week. The dollar amount of drug use consequences was also comparatively lower at the 12 month mark for MDFT patients.

When compared to the control group, MDFT produced greater increases in family togetherness, youth self-concept, and school bonding and decreases in association with delinquent peers in a randomized clinical trial that involved youths who drank alcohol, smoked marijuana, and exhibited antisocial behavior. In yet another study that compared the effectiveness of an outpatient version of the program with an inpatient drug treatment program targeted towards teens, preliminary reports show that the clinical benefits of both programs to be relatively the same. However, the teens in the MDFT program continued to decreased or abstain from drug use and did not continue exhibiting signs of behavior disorders for up to one year after the end of the program. The opposite was true with the youths in the residential program. The MDFT program was also significantly cheaper coming in at $384 per week compared to the $1,138 per week for the inpatient program.

We conducted our own research into why the Multidimensional Family Therapy program has been so effective and have found a link between two singular but interdependent aspects of the program: the relationship between the therapist and the teen, and the relationship between the parent(s) and the therapist. These two factors have been shown to affect patient engagement and retention in their treatment. Other studies conducted on the program were focused on ways to establish better alliances with the treated teens and their parents, improving parental psychosocial functioning, ways to make the therapeutic sessions more productive, and engaging teens in their treatment using culturally specific methods.