Multidimensional family therapy

Domain V · Systemic, relational, group & community · Howard Liddle · 2002 · University of Miami, USA

What it is

MDFT is a manualised, licensed family-based treatment for adolescents (roughly 10–21) with substance use and related problems: delinquency, aggression, school failure and co-occurring mental health disorders. Its core idea is that adolescent problems are multidimensional. Risk and protection…

Format

• Adolescent: engagement in treatment; motivation; drug use and related risk behaviour; emotional symptoms; identity, peer relations and prosocial involvement; skills; school reconnection; preparing the teenager for family sessions.
• Parent: engagement; raising emotional and behavioural involvement (love and commitment); reducing burnout; monitoring, limit-setting and house rules; parents working as a team; psychoeducation on age-appropriate expectations; parents' own substance use or mental health needs (with referral);…

Who practises it, and how they are trained or regulated

• Team: 3–5 certified therapists, one of whom is team supervisor, with weekly case meetings. Minimum for a new US site: two therapists and one supervisor.
• Only certified agencies and therapists may deliver MDFT under its name, with full participation in MDFT quality assurance. Interventions must be designed in consultation with the MDFT trainer.
• Therapist pathway (as of 2024): 2.5–4 days of introductory training (20–32 h); 1–2 h of weekly study; up to 16 consultation calls of about 1–1.5 h (at least 13 required), each trainee presenting a training case; two intensive video reviews (months 1–2 and 5–6); two days of on-site live supervision (months 3–4); two knowledge assessments. Trainees start with no more than two training cases, take new cases monthly and…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the therapist doing it all. Hand over gradually.
• information used as ammunition against the teenager.
• sessions that turn into history-telling. Steer back to now.
• abrupt endings after a good week. Plan the taper in advance.
• shame and withdrawal. Frame it as support for the parent, not blame.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.