Brief Strategic Family Therapy
Brief Strategic Family Therapy (BSFT) uses a structured family systems approach to treat families with children or adolescents (6 to 17 years) who display or are at risk for developing problem behaviors including substance abuse, conduct problems, and delinquency. There are three intervention components. First, counselors establish relationships with family members to better understand and ‘join’ the family system. Second, counselors observe how family members behave with one another in order to identify interactional patterns that are associated with problematic youth behavior. Third, counselors work in the present, using reframes, assigning tasks and coaching family members to try new ways of relating to one another to promote more effective and adaptive family interactions. BSFT is typically delivered in 12 to 16 weekly sessions in community centers, clinics, health agencies, or homes. BSFT counselors are required to participate in four phases of training and are expected to have training and/or experience with basic clinical skills common to many behavioral interventions and family systems theory.
Brief Strategic Family Therapy is rated as a well-supported practice because at least two studies with non-overlapping samples carried out in usual care or practice settings achieved a rating of moderate or high on design and execution and demonstrated favorable effects in a target outcome domain. At least one of the studies demonstrated a sustained favorable effect of at least 12 months beyond the end of treatment on at least one target outcome.
Date Research Evidence Last Reviewed: Mar 2020
Sources
The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, the program or service manual, and the studies reviewed.
Program/Service Webpage Updated: Dec 2020
This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the download the Handbook of Standards and Procedures, Version 1.0
Target Population
BSFT is designed for families with children or adolescents (6 to 17 years) who display or are at risk for developing problem behaviors including: drug use and dependency, antisocial peer associations, bullying, or truancy.
Dosage
BSFT is typically delivered in 12 to 16 weekly sessions, depending on individual and family needs.
Location/Delivery Setting
Recommended Locations/Delivery Settings
BSFT can be delivered in a variety of settings such as community centers, clinics, health agencies, and homes.
Location/Delivery Settings Observed in the Research
- Home
- Mental Health Center, Treatment Center, Therapist Office
- School
- Hospital/Medical Center
Education, Certifications and Training
BSFT is delivered by trained therapists, typically with at least a master’s degrees in social work, marriage and family therapy, psychology or a related field. Therapists are expected to have training and/or experience with basic clinical skills common to many behavioral interventions and family systems theory.
BSFT training consists of live workshops that address especially complex clinical dilemmas and allow time for therapists to practice essential skills. The workshops are a combination of didactics, practice exercises and videotape analysis of BSFT family sessions. They also include clinical case consultations and live family sessions if desired. BSFT training also consists of a supervision practicum that begins 1-2 weeks after the initial workshop and continues for 4-6 months depending on trainee advancement. This supervision practicum entails weekly phone reviews of the trainees’ electronically recorded BSFT family therapy sessions, along with group feedback and consultation.
Sites that wish to offer BSFT are initially required to demonstrate readiness for integrating the BSFT program into their organization. To that end, a Site Readiness process is implemented prior to training. After sites successfully complete training and meet competency and fidelity requirements, they are then licensed. Both the Brief Strategic Family Therapy Institute and the Family Therapy Training Institute of Miami license sites.
Program or Service Documentation
Book/Manual/Available documentation used for review
Szapocznik, J. Hervis, O., & Schwartz, S. (2003). Brief Strategic Family Therapy for adolescent drug abuse (NIH Pub. No. 03-4751). National Institute on Drug Abuse.
Available languages
Materials for BSFT are available in English and Spanish.
For More Information
Brief Strategic Family Therapy® Institute
(305) 243-7585
Family Therapy Training Institute of Miami
(305) 859-2121
https://brief-strategic-family-therapy.com/
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| Results of Search and Review | Number of Studies Identified and Reviewed for Brief Strategic Family Therapy |
|---|---|
| Identified in Search | 6 |
| Eligible for Review | 5 |
| Rated High | 1 |
| Rated Moderate | 1 |
| Rated Low | 3 |
| Reviewed Only for Risk of Harm | 0 |
| Outcome | Effect Size
 and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
|---|---|---|---|---|
| Child well-being: Behavioral and emotional functioning |
-0.06
-2 |
1 (5) | 327 |
Favorable:
1 No Effect: 3 Unfavorable: 1 |
| Child well-being: Substance use |
-0.13
-5 |
1 (17) | 420 |
Favorable:
0 No Effect: 17 Unfavorable: 0 |
| Child well-being: Delinquent behavior |
0.31
12 |
1 (4) | 261 |
Favorable:
4 No Effect: 0 Unfavorable: 0 |
| Adult well-being: Parent/caregiver substance use |
Not Calculated
|
1 (2) | 480 |
Favorable:
1 No Effect: 1 Unfavorable: 0 |
| Adult well-being: Family functioning |
0.06
2 |
2 (8) | 455 |
Favorable:
1 No Effect: 7 Unfavorable: 0 |
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.
| Outcome | Effect Size
and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
Months after treatment when outcome measured
|
|---|---|---|---|---|---|
| Child well-being: Behavioral and emotional functioning |
-0.06
-2 |
1 (5) | 327 |
Favorable:
1 No Effect: 3 Unfavorable: 1 |
- |
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group (Horigian, 2013) | |||||
| Diagnostic Interview Schedule for Children-Predictive Scales: Anxiety (Child Report) |
-0.09
-3 |
- | 315 | - | 4 |
| Diagnostic Interview Schedule for Children-Predictive Scales: Anxiety (Parent Report) |
-0.38
*
-14 |
- | 327 | - | 4 |
| Diagnostic Interview Schedule for Children-Predictive Scales: Depression (Child Report) |
-0.02
0 |
- | 315 | - | 4 |
| Diagnostic Interview Schedule for Children-Predictive Scales: Anxiety (Parent Report) |
-0.10
-4 |
- | 327 | - | 4 |
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group (Horigian, 2015a) | |||||
| Adult Self Report: Externalizing Behaviors |
0.30
*
11 |
- | 261 | - | 50 |
| Child well-being: Substance use |
-0.13
-5 |
1 (17) | 420 |
Favorable:
0 No Effect: 17 Unfavorable: 0 |
- |
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group (Horigian, 2015a) | |||||
| Timeline Follow-Back: Mean Drug Use Days |
0.05
2 |
- | 261 | - | 50 |
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group (Robbins, 2011) | |||||
| Timeline Follow-Back: Drug Use Days (Month 1) |
Null
not calculated |
- | 420 | - | 0 |
| Timeline Follow-Back: Drug Use Days (Month 2) |
Null
not calculated |
- | 403 | - | 0 |
| Timeline Follow-Back: Drug Use Days (Month 4) |
Null
not calculated |
- | 373 | - | 0 |
| Timeline Follow-Back: Drug Use Days (Month 5) |
Null
not calculated |
- | 362 | - | 0 |
| Timeline Follow-Back: Drug Use Days (Month 6) |
Null
not calculated |
- | 357 | - | 0 |
| Timeline Follow-Back: Drug Use Days (Month 7) |
Null
not calculated |
- | 335 | - | 0 |
| Timeline Follow-Back: Drug Use Days (Month 8) |
Null
not calculated |
- | 335 | - | 0 |
| Timeline Follow-Back: Drug Use Days (Month 9) |
Null
not calculated |
- | 326 | - | 1 |
| Timeline Follow-Back: Drug Use Days (Month 10) |
Null
not calculated |
- | 325 | - | 2 |
| Timeline Follow-Back: Drug Use Days (Month 12) |
Null
not calculated |
- | 311 | - | 4 |
| Positive Urine Test for Drug Use (Month 1) |
-0.01
0 |
- | 371 | - | 0 |
| Positive Urine Test for Drug Use (Month 6) |
-0.21
-8 |
- | 296 | - | 0 |
| Positive Urine Test for Drug Use (Month 7) |
-0.25
-10 |
- | 282 | - | 0 |
| Positive Urine Test for Drug Use (Month 8) |
-0.27
-10 |
- | 284 | - | 0 |
| Positive Urine Test for Drug Use (Month 9) |
-0.20
-7 |
- | 286 | - | 1 |
| Positive Urine Test for Drug Use (Month 11) |
-0.04
-1 |
- | 254 | - | 3 |
| Child well-being: Delinquent behavior |
0.31
12 |
1 (4) | 261 |
Favorable:
4 No Effect: 0 Unfavorable: 0 |
- |
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group (Horigian, 2015a) | |||||
| Number of Arrests in Lifetime |
0.34
*
13 |
- | 261 | - | 50 |
| Number of Arrests in Past Year |
0.26
*
10 |
- | 261 | - | 50 |
| Number of Incarcerations in Lifetime |
0.33
*
13 |
- | 261 | - | 50 |
| Number of Incarcerations in Past Year |
0.29
*
11 |
- | 261 | - | 50 |
| Adult well-being: Parent/caregiver substance use |
Not Calculated
|
1 (2) | 480 |
Favorable:
1 No Effect: 1 Unfavorable: 0 |
- |
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group (Horigian, 2015b) | |||||
| Addiction Severity Index-Lite: Alcohol Use |
Favorable
*
not calculated |
- | 480 | - | 4 |
| Addiction Severity Index-Lite: Alcohol and Drug Use |
Null
not calculated |
- | 480 | - | 4 |
| Adult well-being: Family functioning |
0.06
2 |
2 (8) | 455 |
Favorable:
1 No Effect: 7 Unfavorable: 0 |
- |
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group (Robbins, 2011) | |||||
| Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Parent Report) |
-0.06
-2 |
- | 382 | - | 0 |
| Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Parent Report) |
0.06
2 |
- | 333 | - | 0 |
| Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Parent Report) |
0.21
8 |
- | 327 | - | 4 |
| Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Child Report) |
0.01
0 |
- | 375 | - | 0 |
| Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Child Report) |
0.03
1 |
- | 331 | - | 0 |
| Parenting Practices Questionnaire and Family Environment Scale: Family Functioning (Child Report) |
0.02
0 |
- | 318 | - | 4 |
| Study 10573 - BSFT vs. Group Treatment Control (Santisteban, 2003) | |||||
| Family Environment Scale: Conflict (Adolescent Reported) |
-0.34
-13 |
- | 73 | - | 0 |
| Structural Family Systems Rating: Total Score |
0.70
*
25 |
- | 52 | - | 0 |
*p <.05
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.
Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.
Full citations for the studies shown in the table are available in the "Studies Reviewed" section.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 10570 - Brief Strategic Family Therapy (BSFT) vs. Treatment As Usual Comparison Group | ||||||
| Characteristics of the Children and Youth | ||||||
| USA | 2004 | Mean age: 15 years |
44% Hispanic 31% White, non-Hispanic 23% Black, non-Hispanic 2% Other |
79% Male 21% Female |
73% Drug abuse/dependence diagnosis; 27% Alcohol abuse | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| USA | 2004 | Mean age: 43 years | -- |
85% Female 15% Male |
-- |
21% > $50,000 7% $40,000 - $49,999 10% $30,000 - $39,999 17% $20,000 - $29,999 25% $10,000 - $19,999 18% < $10,000 |
| Study 10573 - BSFT vs. Group Treatment Control | ||||||
| Characteristics of the Children and Youth | ||||||
| Miami, FL, USA | -- | Mean age: 15.6 years; Age range: 13-17 years |
51% Cuban 14% Other Hispanic nationalities 14% Nicaraguan 10% Colombian 6% Puerto Rican 3% Peruvian 2% Mexican |
75% Male | -- | -- |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated High
Study 10570Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., . . . Szapocznik, J. (2011). Brief Strategic Family Therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713-727.
Horigian, V. E., Weems, C. F., Robbins, M. S., Feaster, D. J., Ucha, J., Miller, M., & Werstlein, R. (2013). Reductions in anxiety and depression symptoms in youth receiving substance use treatment. The American Journal On Addictions, 22(4), 329-337. doi:10.1111/j.1521-0391.2013.12031.x
Horigian, V. E., Feaster, D. J., Robbins, M. S., Brincks, A. M., Ucha, J., Rohrbaugh, M. J., . . . Szapocznik, J. (2015a). A cross‐sectional assessment of the long term effects of Brief Strategic Family Therapy for adolescent substance use. The American Journal On Addictions, 24(7), 637-645. doi:10.1111/ajad.12278
Horigian, V. E., Feaster, D. J., Brincks, A., Robbins, M. S., Perez, M. A., & Szapocznik, J. (2015b). The effects of Brief Strategic Family Therapy (BSFT) on parent substance use and the association between parent and adolescent substance use. Addictive Behaviors, 42, 44-50. doi:10.1016/j.addbeh.2014.10.024
Robbins, M. S., Szapocznik, J., Horigian, V. E., Feaster, D. J., Puccinelli, M., Jacobs, P., . . . Brigham, G. (2009). Brief Strategic Family Therapy for adolescent drug abusers: A multi-site effectiveness study. Contemporary Clinical Trials, 30(3), 269-278. doi:10.1016/j.cct.2009.01.004
Feaster, D. J., Robbins, M. S., Horigian, V., & Szapocznik, J. (2004). Statistical issues in multisite effectiveness trials: The case of Brief Strategic Family Therapy for adolescent drug abuse treatment. Clinical Trials, 1(5), 428-439.
Horigian, V. E., Robbins, M. S., Dominguez, R., Ucha, J., & Rosa, C. L. (2010). Principles for defining adverse events in behavioral intervention research: Lessons from a family-focused adolescent drug abuse trial. Clinical Trials, 7(1), 58-68. doi:10.1177/1740774509356575
Robbins, M. S., Feaster, D. J., Horigian, V. E., Puccinelli, M. J., Henderson, C., & Szapocznik, J. (2011). Therapist adherence in Brief Strategic Family Therapy for adolescent drug abusers. Journal of Consulting and Clinical Psychology, 79(1), 43-53.
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Rated Moderate
Study 10573Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W. M., Schwartz, S. J., LaPerriere, A., & Szapocznik, J. (2003). Efficacy of Brief Strategic Family Therapy in modifying hispanic adolescent behavior problems and substance use. Journal Of Family Psychology, 17(1), 121-133.
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Rated Low
Study 10571Nickel, M., Luley, J., Krawczyk, J., Nickel, C., Widermann, C., Lahmann, C., . . . Loew, T. (2006). Bullying girls - changes after Brief Strategic Family Therapy: A randomized, prospective, controlled trial with one-year follow-up. Psychotherapy And Psychosomatics, 75(1), 47-55.
This study received a low rating because the standards for addressing missing data were not met.Study 10572
Nickel, M. K., Muehlbacher, M., Kaplan, P., Krawczyk, J., Buschmann, W., Kettler, C., . . . Nickel, C. (2006). Influence of family therapy on bullying behaviour, cortisol secretion, anger, and quality of life in bullying male adolescents: A randomized, prospective, controlled study. Canadian Journal Of Psychiatry, 51(6), 355-362.
This study received a low rating because the standards for addressing missing data were not met.Study 10569
Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief Strategic Family Therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313-332.
This study received a low rating because it did not meet design confound standards.Studies Not Eligible for Review
Study 10574
Valdez, A., Cepeda, A., Parrish, D., Horowitz, R., & Kaplan, C. (2013). An adapted Brief Strategic Family Therapy for gang-affiliated Mexican American adolescents. Research on Social Work Practice, 23(4), 383-396.
This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6)