Different approaches are available for the treatment of substance use and abuse disorders. The choice of method therefore depends on the specific symptoms exhibited by the patients and their support systems. Psychodynamic methods have been used extensively in the past for substance use issues across all populations with significant positive outcomes. However, there are other methods that may also have the same effects such as the multidimensional family therapy, which is used in the treatment of co-occurring substance abuse and other disorders. In most cases however, a single method is never completely successful in the treatment of such disorders and the most effective approaches take into consideration various other factors including the environment of healing and response to withdrawal procedures. Accordingly, the components of effective drug and substance use treatment may involve family services, medical services, mental health services, legal services, vocational services, and educational services among others. It is thus deductible that both psychodynamic therapy and multidimensional family therapy can have equally impactful positive outcomes when used in combination with other methods.
Psychodynamic and Multidimensional Family Therapy
Overview: Conceptualization of Substance Abuse
Multidimensional family therapy is increasingly being recognized as a strategy for the treatment of substance use and abuse disorders. In the past, the psychodynamic therapy has been the most commonly used approach for the treatment of substance use and abuse disorders. The multidimensional family therapy is particularly applicable where the drug abuse issues are correlated to other factors that are based within the family model. According to Rowe (2011), the multidimensional family therapy process is more suitable to cases such as those involving adolescents whose drug use issues have other co-occurring problems within the family. Its main objective is to address the substance use issues alongside other issues that may be linked to family-based risk factors. For adolescents specifically, the prevalence of co-occurrence of substance abuse with other family issues may be as high as 60%, and increases to 90% in certain cultures (Rowe, 2010). A treatment method that takes into consideration this co-occurrence is thus necessary. Accordingly, the use of the multidimensional family therapy method takes a more comprehensive approach to patient assessment in that the service provider has to dig deep into family issues to determine any underlying factors. The treatment plan also has to incorporate various specific elements that trigger substance use among the targeted individuals.
The multidimensional family therapy model maintains that substance abuse disorders are rarely independent of other psychiatric and developmental problems. The theory holds that in most cases, substance abuse is a manifestation of various mental health issues co-existing in an individual, and that effective treatment requires an understanding of the entire range of comorbidities that exist alongside the manifested substance abuse issues (Liddle, Rodriguez & Marvel, 2017). To do this effectively, the inclusion of family and social systems of the affected individuals in the treatment process is imperative. This view is distinct from other views of substance abuse such as that held in the psychodynamic therapy model, which considers substance abuse as an independent mental health issue (Verma & Vijayakrishnan, 2018). Under the psychodynamic therapy model, substance abuse is that treated without consideration of the possibility of other conditions, except where the evidence for the existence of such conditions is glaring.
Despite the perspectives held by these different treatment models, substance use is a common problem that the society deals with on a day to day basis. The prevalence of substance use and abuse especially among youths is an indication of the need for strategies that address substance use within the society, and the consideration of substance use as an issue of public concern (Roberts & Fishbein, 2019). Several social factors have been associated with substance use and abuse, including family systems, parenting skills, peer influence and mental health issues among others. Each case of substance abuse presents a different etiology, and understanding the motivations behind the etiology is imperative if a good solution is to be found for substance use issues in the society today. Jadidi and Nakhaee (2014) particularly conducted a study to explore the various factors associated with substance use disorders as a strategy to determine the effectiveness of different treatment approaches. The authors suggested that family and peer influences have a strong impact on substance abuse tendencies, and that based on that information, effective managing of substance use disorders should take into consideration all familial and peer factors. This argument and the exploration of substance use etiology, indicates the importance and potential effectiveness of the multidimensional family therapy model for substance use disorders, in spite of its low prevalence of application.
Both approaches to the management of substance use disorders have different pros and cons. The strengths of the multidimensional family therapy model for instance include, its ability to address co-occurring psychiatric and developmental issues alongside substance use; comprehensiveness; development focused approach; high efficacy, and impacts on family relationships (Liddle et al., 2017). Alternately, its cons include only the limited application in the contemporary times and the time consuming process as it is implemented in a multi-level approach involving four stages. The psychodynamic approach on the other hand, is associated with strengths such as versatility, encouragement to pursue other forms of therapy based on findings, recognition of the impacts of the subconscious on behavior (Khantzian, 2015). Conversely, it ignores the contributions of biological factors to substance use behaviors.
The treatment process beginning from the patient assessment takes 4 different domains in the multidimensional family therapy model. These domains include the affected individuals (patient system), ‘parents’ domain with their family members, family interactional patterns, and extra familial influence as the key determinants of substance abuse. The assessment involves data collection on each of the domains to compile a holistic outlook of the substance use issue in the patient. Clinicians working with the multidimensional family therapy model commonly use various assessment tools such as the adolescent and family focus factor, which consists of 11 factors, designed as questions to patients (Hogue, Dauber, Samuolis, & Liddle, 2006). The adolescent and family focus factor collects data across all the four mentioned domains.
Since the approach is most commonly used to address substance abuse among adolescents, the patient system in this case is also referred to as the adolescent domain and focuses on the engagement of patients to build a therapeutic alliance. The first step in the assessment process is thus for the provider to develop good rapport with the patient and have them communicate about challenges and experiences spanning the four domains. As part of the adolescent domain, the service provider also collects information on the feelings and thinking patterns of the adolescents (Rowe, 2010). The assessment herein is aimed at gaining sufficient information that can foster treatment planning towards promoting effective communication with parents as well as other adults; solving social problems effectively without resorting to drug abuse and fostering social competence.
In the parent domain, assessment focuses on collecting information pertaining to parental engagement in the treatment process, increasing the extent of emotional and behavioral involvement between parents and their children and improving the level of parental monitoring for adolescents. In case of adults, this would be an exploration of the family level supports including the presence of children in the household (Danzer & Rieger, 2015). The parent domain is intricately connected with the interactional domain, in which the patients and their families are assessed jointly to enable the therapist to observe the types and characteristics of interactions that occur within the family. The objective of this assessment level is to determine the patterns of emotional attachment and communication within the family, which also have an influence on behavior.
The last assessment domain is the extra familial domain, in which assessment seeks to establish the characteristics of the social systems within which the patient exists. The social system influences the competency and involvement of the patient in the journey towards recovery from drug use disorders (Danzer & Rieger, 2015). This is mostly due to the assumption that social behaviors are a function of peer influence besides the family influence.
Considering the extent of assessment associated with the multidimensional family therapy model, it is deductible that the model is holistic. The conventional therapy assessment process applied in psychodynamic therapy entails a consideration of various individual aspects categorized into biological, environmental, social, and family factors (Verma & Vijayakrishnan, 2018). The difference between the assessment conducted in multidimensional family therapy and that conducted in psychodynamic therapy is the objective of the assessment in that in the former, the findings across all the domains of assessment are incorporated in the development of the treatment plan. In the psychodynamic therapy process on the other hand, the developed treatment plan focuses on addressing the substance abuse issue while only referring the patient for further treatments to address the other issues (Khantzian, 2015). As such, those who undergo psychodynamic therapy are more likely to relapse compared to those who undergo multidimensional family therapy model.
Treatment Planning and Approaches
From the patient assessment, each of the models transitions into treatment planning and subsequent implementation. Effective communication is essential in order to sustain the treatment plan to its logical conclusion when using the multidimensional family therapy model. The multidimensional family therapy process entails interactions with multiple groups of people and adhering to culturally competent care practices and to good communication skills is mandatory for success to be realized. The relationship between the patient and their family and the therapist has to be characterized by respect, trust and focus on a common goal to ensure success. This initial stage of treatment is aimed at building good communication strategies and establishing a respectful and trustworthy relationship with the therapist, which help in achieving contextual and developmental understanding of the substance use issues under treatment, and creating an environment for self- motivation towards seeking recovery. The second step in the treatment process is by working with specific goals in each of the four domains. The goals in each of the domains make it easy to monitor and evaluate progress and to provide support for the patient and to their families during the treatment process. Specific approaches to be implemented in this stage include scheduled appointments, adherence to treatment plan requirements, frequent recall of treatment goals, performance monitoring based on self and family reports, and call for support where needed. Subsequently, the process of solidifying change is followed. Change solidification means that the therapist has to use tools such as individual and family reflection to identify areas that may pose problems in the future and to outline strategies for addressing those problems.
For a therapist using the psychodynamic therapy model on the other hand, treatment techniques would begin by creating good rapport and strong communication with patients and their families. The specific techniques including self-reports and reflection processes would also be used in patient treatment. The difference between the two treatment methods however, is that the psychodynamic therapy model does not include family members in the treatment process. Because of these differences, it is important for clinicians to first conduct a comprehensive patient assessment before finalizing on the method to ascribe to. Through the assessment, a clinician can determine whether a patient needs psychodynamic therapy or multidimensional family therapy for a more effective outcome.
Considering the mode of treatment associated with the multidimensional family therapy model, it is deductible that the approach takes into consideration the patient’s unique psychosocial context. The treatment encompasses the existing psychiatric and developmental disorders, the race and socio-economic status which both define family interactions, age and social contexts among others. Through the 4 domains, the treatment plans developed can address all these factors, and the inclusion of different social contributors to the healing process can help in realizing more holistic treatment compared to what can be achieved with other approaches such as psychodynamically informed therapy.
Assessment and Evaluation
The common approach to evaluating the treatment effectiveness of the multidimensional family therapy based substance abuse therapy is through the treatment solidification procedure. Van der Pol et al. (2017) report that the multidimensional family therapy approach is more effective compared to other conventional therapy processes for substance use and abuse. Besides the dependence on self-reports from patients, the treatment solidification process is a collaborative approach to evaluation and monitoring, in which the family members and parents of the patients are involved in the establishment of goals for reference both during and after treatment in order to sustain the changes realized. Since family members are constantly in the picture both for familial and extra familial interactions with the treated individuals, the multidimensional family therapy approach leverages their presence to ensure effectiveness of evaluation. Reports are collected from family in addition to those from patients on progress towards the common goals. Treatment comes to an end upon the assurance, from all the parties to the treatment process, that the treatment has been effective and that projected future risks and challenges are clearly stipulated, understood by all members (patient and his/her family), and the necessary measures have been put in place for addressing those challenges when they emerge. To terminate the treatment, a therapist may convene a meeting with all the parties for documentation and recommendation of best practices moving forward. The involvement of family members then helps to eliminate the probability of relapse.
The evaluation process is contrary to what usually happens in other therapy approaches including psychodynamic therapy, whereby the therapist makes the decision to terminate treatment based on the self-reports from the patient and their own observations (Gatta et al., 2019). With the termination procedure for the psychodynamic process, there is a high likelihood of relapse. Moreover, the psychodynamic therapy process is not as effective as it does not holistically address all co-occurring conditions and the therapist may be forced to refer the patient for other treatment methods.
Research has linked the multidimensional family therapy approach to high levels of efficiency and effectiveness. For instance, van der Pol et al. (2017) report that for individuals with high to severe substance abuse disorders, the multidimensional family therapy process fosters effectiveness in treatment with limited probabilities of relapse. The effectiveness of treatment is more evident in those with severe conditions than in those with mild substance abuse disorders. This could be attributed to the minimum visibility of co-occurring conditions in those with mild substance abuse disorders, which may result in ineffective treatment of those underlying conditions, thereby resulting in future relapse. Another study by Liddle et al. (2017) described multidimensional family therapy as one of the leading multicomponent treatment methods that is developed from evidence-based practice and is theory derived. On the other hand, research on psychodynamic therapy shows that it is one of the traditionally effective methods for substance abuse intervention. The choice of method should therefore be based on the intended outcomes.
By working on this research, I have been able to understand the rationale behind beginning patient interactions for substance abuse disorders with the assessment process prior to concluding on the best approach to use. The conventional approaches to substance abuse intervention have been entrained deeply in practice, resulting in the common perception that the existing and commonly used methods are the most effective. Working on this research has made me realize that substance abuse or rather “addiction” is not always a free standing psychological issue. The consideration of co-occurring conditions has specifically been a point of enlightenment to me. I now consider good interventions as those which focus on holistic healing, and I am bound to use multidimensional family therapy or any other such therapy that uses a broad perspective of substance abuse in designing treatment plans and selecting treatment methodologies, and in which treatment of individuals with substance use disorders takes into consideration their families.
Through the research, I have acquired various new knowledge that I think will be beneficial to for future application. Particularly, I have noted the challenges and weaknesses of the psychodynamic therapy process, and I am certain that those challenges can result in prolonged therapy for individuals with substance use disorders. Despite being recognized as one of the most commonly applied intervention methods for substance abuse, it is clear that the psychodynamic therapy approach leaves a lot of gaps that increase the risk of relapse, unlike a less common such as the multidimensional family therapy approach to substance abuse treatment. This calls for considerate determination of intervention processes for application in particular clinical application contexts.
Considering the intervention process associated with the multidimensional family therapy model and my personal strengths, I can say that I am better placed to apply this approach in practice. First, I believe in holistic healing and it hurts me to see people spending a lot in therapy due to relapse. Secondly, I am a believer in doing things effectively the first time and would thus be frustrated if a patient I handle comes back with the same issues when they could have been prevented effectively the first time. I would thus be more committed and more confident in using the multidimensional family therapy model in future practice.
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