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Demand-Withdraw Interaction in Family Therapy for Adolescent Drug U Kristina N. Rynes, Florencia Lebensohn-Chialvo, Michael J. Rohrbaugh, & Varda Shoham University of Arizona The current study extends this parallel-process idea to family therapy for adolescent drug users. We hypothesized that adolescents entrenched in parent-demand/adolescent-withdraw (PD/AW) interaction before treatment began would show poorer substance-use outcomes if they engaged in parallel therapist-demand/adolescent-withdraw interaction during family therapy. Participants were 91 families who received at least 5 sessions of Brief Strategic Family Therapy (BSFT) for adolescent substance use in NIDA Clinical Trials Network Protocol #014. The adolescents were 12-17 years old (M = 15.9), 80% male, 49% Hispanic, and 15% African American. An average of 3.9 members per family attended at least one therapy session (range = 2 - 9), and 46% of the families had more than one parent figure. Before treatment began, families participated in videotaped family interaction assessment tasks, during which they planned a menu, described what pleased and displeased them about each other, and discussed a recent family argument. A team of trained observers later coded PD/AW interaction during these tasks with intra-class rs > .75 (Rohrbaugh et al., 2007). Another team of raters coded the therapist’s demands (requests) for adolescent change during two family therapy sessions, as well as the adolescent’s response to those demands (accept vs. reject/withdraw), with ICCs > .80. The primary dependent variable was a composite (z-score) index of adolescent substance use based on monthly Timeline Follow-back self-reports and urine drug screens during a 12-month follow-up period. We aggregated the substance-use data by 4-month intervals, yielding 3 outcome assessments in addition to baseline. ______________________________________________________________________________________________________________________________ Correspondence address: Kristina Rynes, Department of Psychology, University of Arizona, P.O. Box 210068, Tucson, AZ 85721-0068 ([email protected]). Ratings of demand-withdraw interaction in a multi-site trial of Brief Strategic Family Therapy for adolescent drug abuse showed complex but intriguing associations with treatment outcome. Attending to parallel demand-withdraw processes in parent-adolescent and therapist-adolescent dyads may be useful in clinical work with families of substance-using adolescents. We analyzed the data in a multi-level model with assessment period and the adolescent (case) intercept as random variables at level 1, while pre-treatment PD/AW, level of therapist demand, and the adolescent’s response (rejection/withdrawal) were fixed variables at level 2. Additional control variables, included as level-2 fixed factors, were the adolescent’s sex, ethnicity, and level of drug use at baseline. Consistent with the study hypothesis, a 3-way interaction of PD/AW x therapist demand x adolescent withdrawal (illustrated in Figure 1) significantly predicted subsequent adolescent substance use, B = 1.06, SE = .44, t(179) = 2.44, p = 0.02. The results s and therapist adolescents. therapeutic s conceptualiza interaction m alliances and Caughlin, J. P adolescents: Relationships 4 3 Adolescent substance use (Z score) Demand-withdraw interaction, a problematic pattern in which one person demands change from another who resists or withdraws, occurs in both marital and parent-child dyads (Caughlin & Malis, 2004; Christensen, 1988). In the treatment domain, intriguing evidence of parallel demandwithdraw processes comes from a study of couple therapy for alcoholic men, where a wifedemand/husband-withdraw pattern predicted poor response to high-demand therapeutic intervention (Shoham et al., 1998). Christensen, A Fitzpatrick (Ed Multilingual M 2 1 0 Rohrbaugh, M Global Structu University of A -1 -2 (1) High adolescent withdraw, High PD/AW (2) High adolescent withdraw, Low PD/AW -3 (3) Low adolescent withdraw, High PD/AW (4) Low adolescent withdraw, Low PD/AW Shoham, V., R interaction mo alcoholism. Jo -4 Low High Therapist demand on adolescent An analysis of the difference in simple slopes within this interaction revealed that, as therapist demand increased, high PD/AW adolescents who withdrew from their therapists used drugs to a somewhat greater degree than did high PD/AW adolescents who did not withdraw from their therapists, t(179) = 1.85, p = .067. Figure 1. Adolescent substance use (z scores) at follow-up predicted by baseline PD/AW, therapist demand, and adolescent rejection/withdrawal during family therapy sessions Th