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Slesnick's Lab

Ecologically-Based Family Therapy (EBFT)

General Description

Ecologically-Based Family Therapy (EBFT) is a family and home-based intervention for families with a drug/alcohol abusing member. The aims of the intervention are to reduce or eliminate family members' drug/alcohol use and related problems through improving family members' emotional connection and interactions. EBFT address the negative interaction dynamic through intervening with family members to increase the ability of family members to hear/take messages of love and support while also increasing their ability to offer/give such messages. Treatment includes sessions or parts of sessions conjointly with all family members living in the home and might also include individual sessions targeted on decision-making, emotion-regulation, or other intrapersonal factors which may be influencing substance use and related problem behaviors.

EBFT Session Description

EBFT includes twelve 50 minute sessions of family work, and can include an additional two to four sessions of HIV prevention with the adolescent. Families in which the youth or parent refuse to meet together are provided up to two individual sessions in order to address and overcome those barriers. Frequent meetings early in therapy capitalize on the momentum of motivated family members to meet and work through the runaway crisis. Treatment is most often provided in the family's home or wherever the youth might be residing (e.g., shelter, foster home). Some family members might be reluctant to have the therapist come into their home for the therapy sessions. In such situations, the family should be invited to meet at the clinic office.

Key Assumptions/Theoretical Background of EBFT

At the theoretical level EBFT is basically an integration of three approaches:

  1. Theory of Social Ecology (Brofenbrenner, 1979)
  2. Contextual Therapy (Boszormenyi-Nagy & Krasner, 1986)
  3. Family Preservation (Nelson & Landsman, 1992)
EBFT is an integration of three approaches

EBFT is based on the recognition that substance use and related individual and family problems derive from many sources of influence and occur in the context of multiple systems. The following assumptions are made:

  1. The family is the primary system in the person's life.
  2. All family members contribute to the development, maintenance, and resolution of problems among its members.
  3. Involvement of family members in the treatment of problems considered intrapersonal (e.g. substance use) will enhance positive individual, family, and social outcomes.
  4. Because families and its members are nested within the larger social system, dysfunction in the primary (family) setting will impact functioning in other settings.
  5. Intervention does not focus solely on the individual, but on the social interactions among all participants that create the type of skill sets and emotional baseline for use in social interactions within and across systems.

Therapists

Therapists must be able to conceptualize behavior problems within a framework that considers the multidimensional nature of problems and family relations. This is central to the successful resolution of any presenting problems. In the research trials, primarily master's level counselors are utilized after receiving a multi-step training and ongoing supervision. The training includes reading materials, discussion, role plays, and co-therapy opportunities.

EBFT Manual

The EBFT manual consists of four sections. Section one operationalizes the engagement procedure utilized with these youth and families. Section two identifies common themes to the therapy with runaway adolescents and families, and organizes an approach to effectively intervene. Section three provides the HIV prevention intervention developed for the runaway youth to be applied in individual meetings. Finally, section four outlines the sequence of clinical tasks for the therapy sessions, including specific techniques used in the therapy process.

Section One: Engagement of Runaway Youth and Their Family

Section Two: Clinical Themes

Section Three: HIV Prevention

Four Session HIV Prevention Protocol for Individual Meetings

Section Four: Outline for Therapy Sessions