Academic journal article Journal of Marital and Family Therapy

Family Therapy Retention: An Observation of First-Session Communication

Academic journal article Journal of Marital and Family Therapy

Family Therapy Retention: An Observation of First-Session Communication

Article excerpt

This study examined the relationship between communication patterns and retention among families (n = 18) receiving family therapy. Those that attended 12 sessions were labeled completers (n = 6), 4-8 sessions were middle dropouts (n = 6), and 1-3 sessions were early dropouts (n = 6). Audiotape recordings of the first therapy session were transcribed. The content (positive or negative) and total percentage of communications by the parent, adolescent, and therapist were coded. Completer and middle dropout parents (but not adolescents) showed higher talk time proportions than parents in the early dropout group. Completer families had higher percentages of therapist-to-parent communications, while early dropout families had higher percentages of therapist-to-adolescent communications. There were no significant differences between middle dropouts and completers in either content or total communications. These findings demonstrate the potential utility of examining within-session communication patterns and suggest that within-session processes may determine therapy retention.

Family therapy is considered an efficacious treatment of adolescent substance abuse and has been associated with improvement in many other realms including parent-child interaction (Liddle, 1996; Liddle et al., 2001; Santisteban et al., 2003; Williams & Chang, 2000). Therefore, retention is an important therapeutic goal so that the family obtains the benefits of treatment. Although several studies have examined predictors of retention for family therapy (Beyebach & Carranza, 1997; Robbins, Turner, Alexander, & Perez, 2003; Robbins et al., 2006), few studies have identified within-session communication processes. An examination of therapeutic process can provide a unique and rich source of information for understanding treatment retention beyond self-report and interview methods alone (Beyebach & Carranza, 1997).


Process research often includes examination of interactional patterns associated with therapeutic change. However, the majority of this research is limited to therapists' and clients' ratings of their perceptions of interactional dynamics prior to and following the therapy session (Beyebach & Carranza, 1997; Fernandez & Eyberg, 2009; Holtzworth-Munroe, Jacobson, DeKlyen, & Whisman, 1989; Oei & Kazmierczak, 1997). While this offers important subjective and attitudinal information that might not be obtained using observational methods, selfreport/interview methods are also limited by respondent bias and measurement error (Kazdin & Nock, 2003).

Using self-report questionnaires administered posttreatment, Beyebach and Carranza (1997) found that clients who interrupted their therapist at higher rates, disapproved of their therapist, and assumed a superior position in discussion were more likely to dropout of therapy than other clients. Using observational methods, Fernandez and Eyberg (2009) coded mother-child interactions before and after therapy sessions and found that more maternal negative talk and less maternal total praise predicted likelihood of dropout. While these studies offer useful information regarding the interactional dynamics that might predict treatment dropout and retention, neither study included observational analysis of in-session communications.

No studies were found that analyzed proportion of talk time as a predictor of treatment completion; however, four studies were identified since 1976 that examined within-session communications as a predictor of family therapy dropout and retention. Overall, lower proportions of supportive compared with defensive communications (Alexander, Barton, Schiavo, & Parsons, 1976), higher rates of resistant communications (Chamberlain, Patterson, Reid, Kavanagh, & Forgatch, 1984), and higher rates of within-family disagreements (Shields, Sprenkle, & Constantine, 1991) were associated with higher dropout rates. …

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