Prosocial family therapy

Aggression and Violent Behavior, Vol. 5, No. 4, pp. 343–378, 2000 Copyright  2000 Elsevier Science Ltd Printed in the USA. All rights reserved 1359-1789/00/$–see front matter

PII S1359-1789(98)00013-5

PROSOCIAL FAMILY THERAPY: A MANUALIZED PREVENTIVE INTERVENTION FOR JUVENILE OFFENDERS Elaine A. Blechman and Kevin D. Vryan University of Colorado at Boulder

ABSTRACT. This manual for Prosocial Family Therapy (PFT) describes a practical method of multisystemic care for juvenile offenders based on our theories about risk and protection factors and therapy process. The PFT team integrates specific parent training techniques and nonspecific family therapy strategies in meetings scheduled with decreasing frequency over a 3-month intervention and 2-year follow-up period. The PFT manual blends scientific and clinical concerns via checks on manual adherence, treatment integrity, and internal validity. PFT can be used by MA-level therapists in community or residential settings run by courts, schools, or mental-health agencies. Our short-term intervention goal is rapid, lasting reduction of youths’ community, home, and coping problems (e.g., police arrest, curfew violation, substance abuse, and suicide attempts). Our long-term prevention goal includes fewer crimes and bad life outcomes (e.g., school dropout, teen parenthood, welfare dependence) and more family-wide prosocial coping—helping self without harming others. We discuss why family preservation is not our ultimate goal and why acceptance of reality is a prerequisite for behavior change.  2000 Elsevier Science Ltd. All rights reserved. KEY WORDS. Family therapy, juvenile offenders, prevention, intention THE FAMILY IS the source of well-documented risk factors for juvenile delinquency and adolescent substance abuse including inadequate parental supervision and monitoring, parental rejection and neglect of children, and parental criminality and substance abuse (e.g., Coley & Hoffman, 1996; Ge et al., 1996; Henry, Caspi, Moffitt, & Silva, 1996; Hoge, Andrews, & Leschied, 1996; Kandel, 1996). Nevertheless, North American courts usually return juvenile offenders to their families during parole, probation, and as an alternative to prosecution (Bazemore & Day, 1996). Multiproblem families are unprepared to provide the long-term support for recovering juvenile offenders that will prevent recidivism and associated bad life outcomes, such as substance abuse (Blechman, 1991).

Correspondence should be addressed to Elaine A. Blechman, Department of Psychology, University of Colorado at Boulder, Boulder, CO 80309-0345; E-mail: [email protected]

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PROSOCIAL FAMILY THERAPY (PFT) In this manual for Prosocial Family Therapy (PFT), we describe how courts, schools, community agencies, and residential treatment centers can provide comprehensive care to juvenile offenders, ensure protocol adherence, and assess clinical significance of results. PFT’s short-term intervention goal is a rapid and lasting multisystemic decline in community, home, and coping problems (e.g., police arrest, school expulsion, curfew violations, sibling fights, substance abuse, parasuicide). PFT’s long-term prevention goal is fewer crimes and bad life outcomes (e.g., school dropout, teen parenthood, welfare dependence) and more family-wide prosocial coping—helping self without harming others. A unique feature of PFT is its manualization of specific behavioral parent training techniques and of nonspecific family therapy and communication strategies.

MANUALIZED INTERVENTION An intervention that is specified in a procedural manual can be adopted and evaluated at sites not biased by the presence of the intervention’s original developers and can be subjected to prospective cost-effectiveness evaluation (Addis, 1997; Cohen, Miller, & Rossman, 1994; Gaston & Gagnon, 1996; Greenwood, Model, Rydell, & Chiesa, 1996). The manual allows users in diverse settings to determine: (a) How well are local therapists adhering to the intervention protocol? (b) In my location, how well does this intervention work? (c) In my location, which clients do particularly well? (d) In my location, which therapists do particularly well? (e) How much does this intervention cost my community compared to locally available alternatives?

OVERVIEW We present here a version of our manual1 with sufficient detail for adoption by courts, schools, community agencies, and residential treatment centers as a means of providing comprehensive care to juvenile offenders, checking protocol adherence, and assessing clinical significance of results.2 This version of the manual also allows independent evaluation of PFT by applied researchers.3 We are currently evaluating PFT with juvenile offenders in Boulder County, CO. Pending the outcome of this research, we make no claims about outcome.4 Section I of this manual considers PFT’s distinguishing features. Section II describes specific PFT techniques. Section III explains how to conduct PFT meetings. We assess therapist adherence to this manual with the checklist in Appendix A. A glossary of PFT terms and acronyms is in Appendix B.

1 Given page limits, this version of the manual omits nonessential details that can be developed by end users. For example, we have omitted details of locally required paper work completed by our PFT teams. 2 We have prepared a series of videotapes for workshop training of PFT therapists. These can be obtained from the first author. 3 We use a standardized assessment protocol for repeated, longitudinal measurement of the juvenile offender population from which PFT participants are drawn. This protocol is available from the first author. 4 A companion article provides single-case experimental design data and excerpts of session transcripts from three families treated according to the protocol described in this manual (Blechman, Helstrom, Hall, Coffey, Piatigorsky, Mascolo & Horstman, 1998).

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DISTINGUISHING FEATURES OF PROSOCIAL FAMILY THERAPY Prosocial Family Therapy (PFT) combines what we view as the best practices of contemporary prevention and intervention approaches for juvenile offenders.5 (a) PFT includes specific techniques for reinforcing days without community, home, and coping problems consistent with behavioral parent training (Blechman, 1985; Forehand & McMahon, 1981; Kazdin, 1997; Patterson, 1975). These same specific techniques set the occasion for skill training of all family members in the fundamentals of communication—information exchange, behavior management, and problem solving (Blechman, Dumas, & Prinz, 1994). (b) PFT includes nonspecific clinical strategies suitable for motivating multiproblem families to change their behavior consistent with structural, strategic, and functional family therapy (e.g., Alexander & Parsons, 1973; Barton, Alexander, Waldron, Turner, & Warburton, 1985; Gordon, Graves, & Arbuthnot, 1995; Minuchin 1974; Minuchin & Fishman, 1981). (c) PFT includes specific techniques for engaging court, school, community agency, and home social systems in the support of behavior change consistent with multisystemic therapy (Borduin et al., 1995; Henggeler, Melton, Smith, Schoenwald, & Hanley, 1993; Henggeler, Schoenwald, & Pickrel, 1995; Henggeler et al., 1994). There are four major differences between PFT and other approaches: theory-driven intervention, intervention viewed as moral education, manualized integration of nonspecific clinical strategies with specific techniques, and specification of the therapeutic process.

Theory-Driven Intervention Serious and stable juvenile offenders. North American juvenile offenders are a heterogeneous group including some youth who should not have been arrested (because they really were not guilty of a crime) and some youth who will be “scared straight” by police and court proceedings. The “early-onset” juvenile offenders at greatest risk for recidivism and for a perpetual criminal lifestyle, and in greatest need of preventive intervention, exhibited externalizing behavior problems at home, at school, and in the neighborhood before school entry (Hamalainen & Pulkkinen, 1996; Moffitt, Caspi, Dickson, Silva, & Stanton, 1996; Stattin & Magnusson, 1996). These “fledgling psychopaths” are serious and stable offenders, impulsive, and more prone to externalizing than internalizing disorders (Lynam, 1996, 1997). The distinctive social, emotional, and cognitive behavior of youth exhibiting what Quay (1993) called “undersocialized aggressive conduct-disorder” are: self-serving cognitive distortions that rationalize antisocial action (Astor & Behre, 1997; Barriga & Gibbs, 1996), a callous-unemotional lack of empathy for other people’s suffering (Cohen & Strayer, 1996; Wooton, Frick, Shelton, & Silverthorn, 1997), guilt-free moral reasoning (Blair, 1997; Blair et al., 1995; Blasi, 1980), “fearless” low anxiety about punishment and excessive focus on immediate gratification and stimulation (Arnett, Smith, & Newman, 1997; Raine, Venables, & Mednick, 1997). Self-centered coping.6 Some people are, more often than not, self-centered, individualistic, or competitive in their coping strategies, concerned about maximizing their personal

5 Juvenile offenders have intervention needs related to current problems (e.g., association with deviant peers, family conflict) and prevention needs related to future arrests and substance abuse (e.g., reliance on antisocial coping strategies) as do their siblings and parents. 6 Assuming a coping-strategy continuum extending from prosocial coping at one extreme to the absence of prosocial coping at the other extreme, how should we label the opposite of prosocial coping? We use the term self-centered coping because our recent findings suggest that an absence of prosocial coping involves use of strategies that are focused on impulsive self-gratifying and distress-reducing actions and that involve no reflection about the consequences of these actions for other people or consultation with other people who might be affected by these actions. Self-centered coping must be distinguished from

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gain regardless of harm to others. Others are primarily prosocial and constructive in their coping strategies, concerned about maximizing gain for themselves and for others (Van Lange, Otten, De Bruin, & Joireman, 1997) in a way that promotes what all participants would agree is a positive social experience (Rydell, Hagekull, & Bohlin, 1997). The capacity to regulate emotional arousal in response to daily stress (rather than to chronically suppress arousal) may be a prerequisite for a constructive, prosocial coping style (Fabes & Eisenberg, 1997). In contrast, the behavior of serious, stable juvenile offenders reflects a self-centered, unconstructive style of coping with social, emotional, and cognitive challenges (Blechman & Culhane, 1993; Blechman, Prinz, & Dumas, 1995). Juvenile offenders, to varying degrees, rely on a self-centered coping style. The most serious and stable juvenile offenders do not feel (or anticipate feeling) anxiety, fear, shame, guilt, or remorse; do not consider the moral implications of their actions; and do not seek or accept help from others (Blair, 1995; Hare, 1978; Hoge, Andrews, & Leschied, 1994; Ogloff & Wong, 1990). Family contributions to delinquency. What roles does the family play in the cultivation of a self-centered coping style that puts youth at risk for delinquency? Parenting demands, after all, that adults cope with a never-ending cascade of challenges presented by growing children. The literature suggests that self-centered coping with childrearing challenges— involving emotional rejection and poor supervision of activities—puts children at risk for delinquency. Smith and Thornberry (1995), using birth to grade 8 longitudinal data for 1,000 students, found a significant relationship between child maltreatment and adolescent official and self-reported delinquency, after controlling for other factors. Results from a longitudinal study of 126 younger brothers (aged 6 to 10 years) of convicted delinquents (Wasserman, Miller, Pinner, & Jaramillo, 1996) supported a cumulative risk model in which each of several Year 1 adverse parenting factors (involvement, conflict, monitoring) further compounded the Year 2 likelihood of child conduct problems. Jang and Smith (1997) using panel data from a representative sample of 838 urban adolescents found that delinquency and inadequate parental supervision are reciprocally related over time, while weak affective ties appear to be a consequence rather than a cause of delinquency, at least by mid-adolescence. In a systematic review of the literature, Loeber and Dishion (1983) found that the principal predictors of delinquency are: parents’ family management techniques (supervision and discipline), the child’s conduct problems, parental criminality, and the child’s poor academic performance. A structural model of the effects of risk-protection factors on delinquents’ life outcomes. Concurrent and longitudinal associations among problem behaviors and bad life outcomes are the basis for numerous competing risk-protection theories proposed to explain the psychosocial development of deviant lifestyles among high-risk youth (see reviews by Hawkins, Catalano, & Miller, 1992; Newcomb & Felix-Ortiz, 1992; Petraitis, Flay, & Miller, 1995). Hawkins et al. list 17 different risk-protection factors and suggest that each continuous risk-protection factor has a direct effect on alcohol and other drug

what some might call ego-resilient coping (and we prefer to call prosocial coping) in which an individual prior to responding to a challenge, appraises personal needs, comes up with a tentative plan of action, contemplates the implications of this plan for other people, consults relevant others about this plan, and modifies the plan accordingly. Imagine a 16-year-old boy who, together with his best friend B.J., has been insulted by a classmate. A self-centered coping response would involve a physical assault on the classmate or drug use to reduce emotional distress. A prosocial coping response would involve an appraisal of the insult and the classmate (“Was he right?” “Is he just a jerk who insults people all the time?”), formulation of a plan of action (“He’s a jerk. I’m going to play ball with B.J. and get over it.”), and, communication with relevant others (e.g., B.J.).

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problems with important prevention implications (“cumulative” model). If Figure 1 portrayed the Hawkins et al. risk-protection theory, the ovals representing latent (theoretical) background, coping, and family risk-protection factors would all be connected directly to the oval representing a latent life-outcome factor. In contrast, Figure 1 suggests that family and coping risk-protection factors moderate the effects of background risk-protection factors, thereby suggesting priorities for prevention and intervention programs (“copingcompetence” model; Blechman, 1996; Blechman & Culhane, 1993; Blechman, Prinz, & Dumas, 1995). This structural model has been the driving force behind the development of Prosocial Family Therapy. Keystone risk-protection factors. In Figure 1, family and coping risk-protection factors have direct effects on delinquents’ life outcomes while moderating the indirect effects of background risk-protection factors (neighborhood, school, and peer group).7 This copingcompetence model is consistent with the view that children who have been traumatized, rejected, or neglected by parents adopt psychopathic behavior as a survival strategy particularly if they are predisposed to do so by genetic endowment (Porter, 1996). The keystone role of coping and family factors distinguishes the coping-competence model from “cumulative” risk-protection models, such as the Hawkins-Catalano model. As indicators of the latent family factor, we chose variables that the literature suggests are essential and somewhat interrelated family variables: family history of antisocial behavior, family income, and parenting (warmth and supervision). We used a similar approach to select indicators of the latent coping factor: behavior problems, cognitive skill, coping style, negative affect, psychopathy, social conformity, substance abuse, and temperament. As indicators of the background risk-protection factor, we have specified subordinate latent constructs (neighborhood, school, and peer group) that appear to subsume the vast array of risk-protection factors cited in the literature. We expect that our general structural model will encompass findings and have practical implications for subgroups of normal and deviant adolescents. Thus, ineffective parental supervision might have a weaker, yet still adverse, effect on life outcomes among youth who score high on measures of psychopathy (e.g., Wooton, Frick, Shelton, & Silverthorn, 1997). Support for the coping-competence structural model. We have cast the family factor as a direct influence on life outcomes and a mediator of the indirect influence of peer groups. This is consistent with Kandel’s (1996) review of major findings regarding parent and peer contexts for adolescent deviance. Calling for further research, she tentatively concludes that the influence of parents has generally been underestimated and that of peers, overestimated. We have cast both family and coping factors as interdependent mediators of the impact of background factors on life outcomes. A study of 207 singleparent families found that for boys, community disadvantage had a direct effect on psychological distress (our coping factor), while it indirectly boosted the probability of conduct problems (our coping factor) by disrupting parenting (our family factor) and increasing affiliation with deviant peers (an interaction among indicators of our background risk-protection factor) (Simons, Johnson, Beaman, Conger, & Whitbeck, 1996). A longitudinal study of 585 children from prekindergarten to grade 6, found that early supportive parenting mitigated the effects of family adversity on later behavior problems (Pettit, Bates, & Dodge, 1997). Intervention implications. The coping-competence model in Figure 1 includes latent “family” and “coping” factors that directly influence youths’ future life outcomes and

7 We are currently testing components of this structural model with confirmatory factor analysis and pathways between constructs with structural equation modeling.

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FIGURE 1. “Keystone” structural model showing coping and family risk-protection factors as moderators of the effects of background risk-protection on future crime and life outcomes. Observed risk-protection indicators (14) are expected to cluster in three latent risk-protection factors: background (3), coping (8), and family (3). Observed indicators of crime (3) and life outcomes (3) are expected to cluster in two latent factors. This model expects that coping and family riskprotection moderate the effects of background risk-protection directly predicting future crime and life outcomes. In a high-risk developmental trajectory, adverse levels of coping and family risk-protection will remain stable or worsen over time. In a resilient trajectory, psychosocial intervention or other “turnaround” events will move family and/or coping in a favorable direction, thereby reducing the adverse, continuing effects of background risk-protection and the risk for future crime and bad life outcomes. A bidirectional arrow suggests interaction between crime and life outcomes. Although not shown there, the keystone model expects: covariation among indicators of each factor, and that current crime and life outcomes will influence future levels of background, coping, and family risk-protection. Over time, the effects of background and family risk-protection is expected to diminish while the influence of coping risk-protection increases.

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mediate or moderate the effects of other risk-protection factors (school, neighborhood, peer group, genetic endowment). One class of observed indicators that is amenable to brief psychosocial intervention (parent warmth, parent supervision, child prosocial coping, child behavior problems, parent and child negative affect) is the focus of PFT intervention efforts. A second class of indicators is amenable to public policy programs (family income). A third class of indicators (child psychopathy and general intelligence) is believed by many to include stable, unalterable traits. However, it is at least possible that a psychosocial intervention with a successful short-term focus on obviously malleable outcomes (prosocial coping, behavior problems, affect) might bring about long-term change in psychopathy or general intelligence. The coping-competence model hypothesizes that the impact of background risk-protection factors on life outcomes passes through “coping” and “family” factors. This implies that youth without families or with very rejecting and neglectful families can be diverted from adverse life outcomes by structured behavioral interventions that do not require family involvement, but do boost prosocial coping skills (cf. Blechman, Dumas, & Prinz, 1994; Haggarty, Wells, Jenson, Catalano, & Hawkins, 1989; Hawkins, Jenson, Catalano, & Wells, 1991).

Intervention as Moral Education The coping-competence model suggests that bad life outcomes result, in part, from juvenile offenders’ own deficits in prosocial coping and from their parents’ deficient warmth and supervision. Socialization of adolescents is a challenge for the most competent parents. Parents of delinquents often fail to cope prosocially with this challenge thereby aggravating the vulnerability of all siblings in the family (MacKinnon-Lewis, Starnes, Volling, & Johnson, 1997). It seems that delinquents, siblings, and parents would benefit from lessons in coping prosocially with challenges at home, at school, at work, and in the neighborhood. Consistent with liberal and conservative interest in “moral” education (Schulman, 1995), or “character” education (Lickona, 1997). PFT is designed to substitute prosocial coping (that helps self without harming others) for self-centered coping (that focuses on shortterm personal gain or distress reduction regardless of harm to others).8

Specification of Therapeutic Process Successful intervention with troubled youth and their families involves a delicate balance between process and outcome. The therapist who focuses exclusively on achieving posttreatment goals without forming a working alliance with family members will fail as surely as the therapist who ignores post-treatment goals in favor of alliance formation (Diguiseppe, Linscott, & Jilton, 1996). Therefore, a manualized intervention such as PFT must identify specific techniques used to achieve post-treatment goals, nonspecific clinical strategies used to form a working alliance, and how techniques and strategies are integrated in clinical practice. In Table 1 we list core nonspecific and prosocial communication strategies that involve sensitivity to others’ needs, beliefs, experiences, and values. When used as the backbone of communication with clients, nonspecific strategies enable the therapist to be maximally sensitive to family members. As Figure 2 suggests, this sensitivity

8 The Coping Strategy Inventory (CSI; Culhane & Blechman, 1997) provides an operational definition for prosocial and self-centered coping via items such as “When you have a problem, do you think carefully about how others feel before deciding what to do?” We are now using the CSI to assess whether PFT achieves its intended goal of increased prosocial coping by all family members.

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Examples “How have we defined a good day?” “When each day do you plan to reward your kids for a good day?” “What privileges are you willing to give your kids at the end of a good day and only at the end of a good day?” “Which of you will have the most good days this week without community problems such as complaining calls from school?” “What’s the purpose of the Reunion Task for your family?” “The Discovery Task?” “The Plan Task?” “In what task do we figure out what we’ve accomplished during the meeting?” “How do we know at the beginning of our meeting how well the Good-Day Plan has been working?” “Why should you (to child) try to have a good day? What will you get out of it? How will your family benefit?” “Why should you (parent) reward (your child) for a good day? What will you get out of it? How will your child benefit?” “What’s wrong with stealing? with lying? with doing drugs? Who gets hurt?” “What’s good about belonging to a gang? doing drugs to make other kids think you’re cool?” “How many kids have friends if they don’t do drugs? If they don’t steal?” “What do you call kids who don’t get in trouble, do well in school, and have a lot of friends?” “How could a Good-Day Plan help you (your child) make friends?” “What’s so bad about your child getting arrested? Going to jail?” “How would your life be better if your child didn’t get arrested, did well in school?”

Usage Tips

Definition: An open-ended question that beings with “who,” “which,” “how,” “when,” “what,” or “why,” and continues with a statement about prosocial, future behavior. Impact: By asking the question, the therapist conveys a sense of optimism. By answering the question, the respondent makes an overt commitment to prosocial behavior or provides a personally relevant rationale for such behavior. Next step: A structuring statement or another leading question. Watch out for: A leading question that asks a person to self-incriminate. (“Why do you think you keep giving inaccurate reports about your son’s progress?” “Why do you think your son is so angry at you?”)

Leading Question or Key Question

TABLE 1. Prosocial Communication Strategies

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(Continued)

Definition: A statement that both summarizes another’s words and checks that “Lets see if I’ve got this right, you say the Good-Day Plan isn’t working and the summary is accurate for the purpose of ensuring accurate comprehension. you say that on Tuesday, the one good day that occurred this week, you Usually includes a quote of the other person’s exact words. didn’t give Johnny a reward. Did I understand you correctly?” (Yes, that’s Uses: (a) To get a complete picture of another’s experience. (b) To identify and what I said.) “What’s the connection between the plan not working and your bring to the other’s attention a central theme that underlies seemingly not giving rewards?” (Leading Question). unrelated events or comments. (c) To point out the ambivalence inherent in a “Sounds to me like the bad news is that you are ‘bummed out’ because you didn’t statement of dissatisfaction, hostility, defiance, or lack of motivation. (d) To even have one good day this week and so you couldn’t get to use the car. The summarize several people’s different perspectives on a particular issue. (e) To good news is that you are thinking about what made it hard for you to have put a positive spin or reframe on a seemingly hopeless situation. a good day so that you could get the car. Is that it?” (Yeah) “So what would Impact: By presenting the CS, the therapist shows careful, thoughtful, helpful help you this week to have at least one good day?” (Leading Question) listening. By agreeing that the CS is accurate (or by offering information “I’m putting together what you’ve just said about coming here only to avoid having that would make the CS more accurate), the respondent feels respected and your son prosecuted with what you’ve told me in past weeks about wanting gains self-knowledge and insight. your son to succeed in life and be a really fine human being who brings your Next step: A related leading question. family pride. Sounds like, in part, you are angry at all the pressure you’ve Watch out for: A statement that does no more that emphasize hostility or been under since your son’s arrest. The other part of you wants the best for resentment. (“So what you are saying is that you’d rather go before the judge your son even if you have to suffer a bit while you are bringing him up the than keep working things out here.”) A statement that does no more than right way.” (Yes, that’s just how I feel, sometimes up, sometimes down.) “So tacitly agree with a rationale for antisocial behavior. (“So you’re saying that you how can you use the pressure from the DA to help your son grow up right?” use drugs because it makes you ‘look cool’ with the other kids?”) (Leading Question)

Clarifying Statement (CS)

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“What we’ll do now is the Discovery Task. In the Discovery Task, we’ll be detectives and discover how the Good-Day Plan worked this past week.” “Who remembers what our next task is? Here’s a hint. It’s something scientists and detectives do all the time.” “Mom and Dad, we’re talking about some upsetting things that have got to be aired and the kids are understandably restless. Mom, please hold Jane’s hand so that she stays in her chair. Dad, please do the same with Tony.” “Have you noticed that while I’m talking if anyone interrupts I just keep talking and say nothing to the person interrupting. Dad, what will you do next time you are interrupted? Mom, what will you do?” “Jane, if you have something to say, how can you get a turn to talk without interrupting?” “Jane, you sit here. Dad you sit here. Mom, here. Tony, here. Dad and Mom it is your job to keep Jane and Tony in their seats. How will you do that?”

Definition: A statement that combines words of praise with a description of the praiseworthy act. Use: Used at every opportunity to reward prosocial statements and actions during and between meetings. Used to turn tentative statements and actions into full-scale commitment and follow-through. Impact: The therapist warmly affirms contributions while increasing the future probability of similar behavior via positive reinforcement. Family members feel their efforts, no matter now small, are recognized and worthy. Next step: A leading question that elicits self-congratulation. Watch out for: Undeserved, dishonest, or unlabelled praise.

“You are great! You worked hard enough to have four good days this week. More than you’ve ever had before! How does that feel?” “What a cool mom you are! As tired as you were this week, you made sure that every good day earned the agreed upon reward. Did you think you could do that when we talked about it last week?”

Descriptive Praise

Definition: A statement that clearly describes (or prompts a description of) the next action an individual or the group will take and provides (or prompts) a rationale for that action. Uses: (a) Used to prescribe actions that individuals or groups are ready and likely to perform. (b) Used to redirect attention away from hostile, defiant, pessimestic, or disruptive statements and actions that can be ignored. (c) Used to manage disruptive behavior during the meeting. (d) Used to prevent disruptive behavior during the meeting. Impact: Family members know what is expected of them and have a personally relevant rationale for action. They feel confidence in the therapist’s expertise. The impact is strongest when a leading question is included in the structuring statement. Next step: Descriptive praise. Watch out for: A statement (or related leading question) that describes an action that is unfamiliar or unlikely to occur. “What should we do next?” “Mom, now you’re going to formulate a contingency contract using negative reinforcement to strengthen the future probability of good days. Go for it!” A statement that shows a lack of confidence or familiarity with PFT procedures, or a lack of self-confidence. “According to my supervisor, what we’re supposed to do next (goodness knows why) is the Discovery Task.”

Structuring Statement

TABLE 1. Prosocial Communication Strategies (Continued)

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FIGURE 2. Therapeutic process in Prosocial Family Therapy. should contribute to the formation of a working alliance and increase parent and child receptivity to specific PFT techniques. Treatment fidelity. Description in a manual of specific techniques and nonspecific strategies is of no use without a mechanism for insuring therapist adherence to the manual. Treatment fidelity is of particular importance when a manual is used for dissemination of an intervention to remote sites. In a test of Multi-Systemic Therapy (MST) across two public sector mental-health sites, 155 juvenile offenders were randomly assigned to MST vs. usual care (Henggeler, Melton, Brondino, Scherer, & Hanley, 1997). Findings for decreased criminal activity were not as favorable as observed on other recent trials of MST apparently because of insufficient treatment fidelity. Therapist self-confidence. Juvenile offenders and their families are adept at challenging people in authority and manipulating them. These clients do not want to be in therapy, they are often angry at the therapist and directly question the therapist’s motivations and expertise. Such clients would seem to do best with a mature, seasoned, and self-confident therapist. Yet, for a variety of reasons, providers of service to these clients are often young, inexperienced, and easily intimidated or conned (e.g., into succumbing to the argument that the parents have no responsibility for the child’s delinquency and no reason to participate in family treatment). By manualizing PFT’s specific techniques and nonspecific strategies from intake through follow-up, by repeatedly checking therapist fidelity, and by making procedural fidelity a prime topic for clinical supervision, we achieved an unexpected and very positive consequence. Therapists at different levels of professional development report that when following PFT procedures they feel confident and focused with the most challenging families.

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Integration of Specific Techniques and Nonspecific Clinical Strategies Identifying core nonspecific strategies. Therapeutic alliance. Expert therapists from every school of therapy rely upon socalled “nonspecific” clinical strategies to form and maintain therapeutic bonds or alliances (Diguiseppe, Linscott, & Jilton, 1996; Kolden, 1996; Oei & Shuttlewood, 1996). The term nonspecific indicates that these strategies are not specific to a particular mode of intervention that is characterized by specific techniques. In the NIMH Treatment of Depression Collaborative Research Program (Krupnick et al., 1996), the therapeutic alliance was found to have a significant effect on clinical outcome for interpersonal psychotherapy, cognitive-behavior therapy, active and placebo pharmacotherapy. Since the change provoked by successful intervention is necessarily stressful for clients, expert therapists know how to maintain the therapeutic bond in the face of client-therapist friction (Omer, 1995; Safran & Muran, 1996). Core nonspecific strategies. Miller and Rollnick (1991) identified and defined nonspecific clinical strategies that are useful in motivating substance abusers to seek treatment. Over a period of years, we have identified four prosocial communication strategies (leading questions, clarifying statements, structuring statements, descriptive praise) that we list and define in Table 1. These four strategies include all the communication maneuvers described by Miller and Rollnick, such as positive reframes. These four nonspecific strategies appear sufficient for establishing, maintaining, and repairing a therapeutic alliance.9 These strategies allow a therapist to create a warm, safe, accepting therapeutic environment where clients want to benefit from PFT’s specific techniques. Therapist training. PFT’s nonspecific strategies are relatively easy to teach to a wellmotivated, psychologically insightful yet novice, master’s level clinician. A good introductory training exercise involves communication for a two-day period with family, friends, and strangers using only these four strategies. Trainees often get surprisingly positive feedback in response. The next step in training involves reliance on the core PFT nonspecific strategies throughout a series of meetings with a client family. We have found that young clinicians can guide families through specific PFT techniques relying exclusively on these four nonspecific strategies. Relying on this framework for communication, young clinicians avoid the risks associated with other communication strategies (e.g., lecturing, direct confrontation, self-disclosure, storytelling), that more seasoned clinicians may use with success. Nonspecific strategies to avoid. While prosocial strategies help the therapist implement specific PFT techniques, we believe that other communication maneuvers interfere with the success of specific techniques by disrupting the therapeutic alliance. We expect therapists to avoid: preaching, threatening, interrupting, careless listening, blaming, gratuitous selffocus, phony empathy, “rescuing” clients in crisis, panicking during crises, overinvolvement in the family’s life, and forming an alliance with one family member or subgroup. Because PFT is designed for use by inexperienced therapists who may function in isolation without adequate supervision, we believe it is very important to point out gaffes that would be nauseatingly obvious to an experienced clinician. Clarification vs. interpretation. To promote change, a therapist must provide clients with a new understanding of old information. Adolescents and their parents enter treatment with fixed and unproductive perspectives on past experience that decrease their

9 Whether these four nonspecific strategies are sufficient for developing and maintaining a therapeutic alliance is an empirical question that we hope to address in the near future.

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awareness of discrepant information and their motivation for personal change. An adolescent may be convinced that parents, teachers, and police are “out to get me.” A mother may be convinced that the child’s delinquency is caused by an attention-deficit disorder and must be treated with drugs. Using clarifying statements, as Table 1 shows, the PFT therapist can artfully pull together discrepant bits of information in a way that gives hope for the future and encourages personal change efforts. We define interpretation as attribution of problem behavior to a historical condition (e.g., early abuse) or to an unobservable entity (e.g., bad genes, the devil, conduct disorder). Consistent with Figure 1, we believe that current style of coping with adversity (rather than adversity per se) determines future life outcomes. Therefore, we discourage PFT therapists from focusing on immutable adversity through interpretations. A false, poorly timed, or ineptly presented interpretation can lead clients to see themselves as helpless victims of past inequities with no control over current behavior (Strupp & Binder, 1984). PFT therapists do not provide interpretations of clients’ behavior, try to elicit interpretations from clients via “why do you think you...” questions, or use interpretations as the basis for designing intervention. Checking adherence to the manual. An In-Session Checklist (Appendix A) is completed by the therapist after session completion and, periodically,10 by a trained observer (of the videotaped session) to document therapist adherence during the session to specific techniques and nonspecific, prosocial communication strategies. The observer provides the therapist and clinical supervisor with completed checklists, and “redlines” instances of nonadherence. Recognizing the difficulties inherent in working with offenders and their families, the supervisor uses prosocial communication strategies to enlist therapists’ involvement in improved manual adherence. Because our ultimate concern is not with the topography or appearance of therapist behavior but with its functional impact on client behavior, the in-session checklist includes core therapist activities (for checks on procedural fidelity) and client activities (for checks on functional impact).

SPECIFIC PFT TECHNIQUES PFT involves eight specific techniques that standardize: longitudinal assessment, brief treatment and extended follow-up, meeting content, intake, psychoeducation, telephone interviews, multiple-baseline design, and good-day plan.

1. Longitudinal Assessment Assessment staff11 administer a standardized battery to youth, parents, and teachers, and collects corroborating information (e.g., from official records) at repeated intervals

10

At the beginning of each month, a supervisor establishes a work schedule for two or more trained observers for the rest of the month, selecting sessions at random to be coded each week (without informing therapists of which sessions will be coded), and identifying sessions which will, to determine inter-observer reliability, be coded by two observers. At the end of each session, therapists can transmit videotapes of the session to the observers’ supervisor for coding. Observers code at least one of a therapist’s sessions with a given family per month, delivering results within the same week for use in clinical supervision. Checks for inter-observer reliability (calculated via Cohen’s Kappa) are conducted on at least 1 of every 10 sessions (from different therapists) coded by an observer. Checks on inter-observer reliability should be sensitive both to agreement between observers and to agreement of each observer with a gold-standard observer, the clinical supervisor. 11 Staff members who conduct assessments are not involved in PFT intervention to ensure that assessment results are unbiased. This expensive division of labor between research and clinical staff is not necessary at sites with exclusively clinical goals.

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TABLE 2. Timeline for PFT Standardized Assessment, Telephone Interviews, and Intervention What Time 1 assessment Juvenile Diversion Program Staff require family therapy as a condition for diversion Intake

When

Telephone Interview

1 week after court appearance 5 weeks after arrest

Phase 1 intervention

At least 1 week before Telephone Interview 1 12 weekly PFT meetings

Time 2 assessment Phase 2 intervention

20–24 weeks after Time 1 6 monthly PFT meetings

Time 3 assessment Phase 3 intervention

1 year after Time 1 6 bimonthly PFT meetings

Time 4 assessment

2 years after Time 1

Weekly for at least 15 weeks. At least three before the PFT meeting. One in the week preceding each PFT meeting. One in the week preceding each PFT meeting

following the youth’s arrest (shown in Table 2). Assessment takes place: within 5 weeks post-arrest and 1 week after court appearance (Time 1), 20-24 weeks after Time 1 (Time 2), 12 and 24 months after Time 1 (Times 3 and 4). The assessment battery measures risk and protection factors (e.g., youth coping, parental involvement) as well as short- and long-term outcomes (e.g., behavior problems). Repeated assessment serves a variety of purposes. (a) Time 1 data provide the basis for a clinical report regarding treatment needs. (b) Comparisons of data collected at Time 1 with data collected at Times 2, 3, and 4 allow for prospective program evaluation. (c) Time 1 data provide invaluable information about predictors of treatment dropout, and of short-term and long-term treatment success.

2. Brief Treatment and Extended Follow-Up When youth and families enter PFT, they commit themselves to a standard course of treatment and follow-up shown in Table 2. Phase 1 occurs between Time 1 and Time 2 assessments and includes 3 weeks of baseline data collection via telephone interviews followed by 12 weekly 50-minute long PFT meetings. Phase 2 includes as many monthly PFT meetings as can be scheduled between the Time 2 and Time 3 assessments; generally there will be 6 meetings in Phase 2. Phase 3 involves as many bimonthly PFT meetings as can be scheduled between the Time 3 and Time 4 assessments.

3. Meeting Content In Phases 1, 2, and 3, PFT meetings have a similar structures (see Table 3). The standard PFT meeting tasks are: Discovery, Reunion, Role-Play, Plan, and Wrap-up. Together the five tasks enable the family to formulate, fine-tune, implement, and maintain a GoodDay Plan (GDP) directed at reducing the frequency of community, home, and coping problems among youthful offenders and their siblings. As families master these tasks, we hope that they will become increasingly less dependent on the therapist for direction

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TABLE 3. Structure of the PFT Meeting First Task: Discovery (5 min) Procedure

Purpose

Together, the family: (a) reviews graphs of Telephone Interview frequency data for community, home, and coping problems in the preceding week, (b) compares the past week’s data with data from preceding weeks or months, (c) draws conclusions about the success of the current Good-Day Plan.

Family gains a realistic appreciation of the extent of current problems and of the family’s progress in addressing these problems.

Second Task: Reunion (10 min) (a) Family members take turns talking about current community, home, and coping problems and about current GDPs. (b) Family members take turns summarizing each other’s narratives and checking out the accuracy of their summaries.

Family members learn to articulate their own points of view and understand each others’ point of view (information exchange).

Third Task: Role Play (10 min) Together, the family role plays: (a) current problems and (b) current GDPs.

Family members practice new ways of interacting (behavior management).

Fourth Task: Plan (20 min) Together, the family: (a) designs, (b) troubleshoots, and (c) refines their GDP.

Family members learn to negotiate mutually agreeable solutions for their joint problems (problem solving).

Fifth Task: Wrap Up (5 min) The therapist: (a) summarizes what was accomplished during the meeting, and (b) addresses any recent crisis.

Family members begin to view crises in perspective and to address crises with their newly developing problem-solving skills.

during the solution of their own problems. At best, they master these tasks and import them as rituals into their daily routine.

4. Intake For intake to PFT, an eligible family meets the treating therapist for a 50- to 90-minutelong intake interview prior to the first Telephone Interview and the onset of PFT Phase 1.12 In our clinic, the therapist schedules an intake meeting after reviewing an extensive test report based on police and court records and the results of a structured interview conducted with offender and parents shortly after the first court appearance (see Blechman et al., 1998). Intake, as described below, would take much longer if it was the first 12 An intake meeting requires from 50 to 90 minutes depending upon support staff available, completion of some intake tasks prior to the intake meeting, and therapist experience.

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occasion for collection of family history, information about the index offense, and other pretreatment data. In the intake meeting, the therapist follows the ordered intake procedures presented below only if these people are present: the juvenile offender, parents or caretakers who reside with or usually care for the offender, and all siblings age 4 and above who reside with the offender.13 The telephone interviewer attends the intake meeting and conducts the first “telephone interview” in person.14 Intake procedures. 1. Introductions and structuring. The therapist greets the family, meets each family member, shows family members where to sit, instructs parents about their responsibilities for controlling their children during the meeting, and instructs all family members about appropriate in-session behavior (e.g., “Listening carefully while others speak”).15 The therapist begins by asking family members to describe what help they want. The therapist uses leading questions to underscore the family-wide benefits of fewer behavior problems and a happier family life. 2. PFT’s benefits and costs. The therapist asks about desired treatment types and treatment providers “if this were an ideal world in which you could have anything you wanted.” The therapist uses structuring statements and audiovisual aids to link a rationale for PFT participation to family members’ preferences. Using family members’ own words whenever possible, the rationale focuses on how this family can reduce behavior problems and be happier by mastering, during PFT, the “7 secrets of happy families.” The “7 secrets” are core psychoeducational principles that are expanded upon by the therapist in the first PFT meeting and alluded to frequently thereafter. The therapist explains the commitment of time, effort, and money required for PFT participation. When a family commits to participation,16 the therapist schedules definite appointments for Phase 1 and approximate appointments for Phases 2 and 3 consistent with the Table 2 timeline.17

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Young children are provided with quiet toys and a corner of the room for play. Inclusion of young children in family meetings adds to the confusion and chaos and increases the realism of these meetings. The family meetings, beginning with intake, function as a stage for parental rehearsal of prosocial behaviormanagement practices under the therapist’s guidance (cf. for methods, Blechman, 1985). 14 Subsequent telephone interviews are conducted over the telephone if the family has a telephone. For families without telephones or families headed by parents who have difficulty keeping written records a home visit by the telephone interviewer is in order. At intake, a reporting or bookkeeper parent is designated. This is the parent most willing and able to keep family records, be available at telephone interviews, and oversee the Good-Day Plan. A child is never assigned this responsibility to avoid inappropriate role allocation. In two-parent households, including households comprised of a biological parent and the parent’s adult companion or of two unmarried adults and their children, both adults should participate in PFT meetings, but only one adult should have the responsibility for record keeping and reporting. This role should not automatically be assigned to the adult woman in the household. Allocation should be based on willingness and ability to fulfill the necessary functions. A good question to ask is, “Who balances the family checkbook? Who gets receipts ready for taxes?” If one parent takes care of record keeping, the other parent could be the one to implement the Good-Day Plan, declaring a “good day,” and dispensing earned rewards. 15 During all PFT meetings, the therapist engages in limit-setting and structuring to prevent any possibility of physical violence. Through prosocial communication, the therapist ensures that all family members buy into their role, responsibilities, and payoff for nonviolent participation in every PFT task and procedure. 16 Although juvenile offenders may be under duress to become involved in some legitimate form of family treatment, family members should, we believe, make the final decision about the treatment provider. 17 This is a good time for family members to provide written informed consent (adults) and assent (minors) to participate in treatment since they are now completely informed about the costs and benefits of PFT participation. This may be the second or third step in obtaining informed consent since family members may provide written consent for participation in the pretreatment assessment process, in the intake

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3. Problem definitions and telephone interviews. We base our appraisal of PFT outcome on objective evidence about offender recidivism and substance abuse. Involvement of all family members in collaborative change, requires a focus on problems of immediate relevance and the collection of daily information about the incidence of these problems. At intake, the therapist helps family members achieve specific and comprehensive definitions of community, home, and coping problems using guidelines shown in Table 4 and explains the telephone-interview schedule shown in Table 2. At this point, the telephone interviewer conducts the first “telephone” interview as described below, gives one parent a supply of telephone report forms, and shows the family how their reports will be graphed. Figure 3 displays an ideal array of telephone-interview data in multiple-baseline format and illustrates our expectations for change in telephone-interview data over time as GoodDay Plans are successively applied across problem types. We certainly do not expect that family members will immediately provide accurate or even consistent reports to the telephone interviewer. In fact, we continuously collect data about community problems from school and court records. However, family members are the only source of information about home and coping problems, and inconsistencies in the reports of family members are the only clues to inaccuracy. During the Discovery Task that begins each PFT session, a focus on weekly telephone report data shifts the focus from long ago to here and now. Weekly therapist clarification of discrepancies among family members’ reports and with outside observers (teachers, police) provides a reality check often absent during family therapy. In a companion article (Blechman et al., 1998), we provide actual single-case telephone interview data for three families and discuss clinical and research issues related to telephone-interview data.

5. Psychoeducation: Seven Secrets of Happy Families The families of juvenile offenders and other at-risk youth are very diverse. Nevertheless, it is our observation that they tend to have in common a lack of self-awareness and a lack of sensitivity to others’ needs. They also share a desire to be happier. For these reasons, PFT provides families with psychoeducational information about prosocial behavior and cognition via the “seven secrets of happy families.”18 The therapist presents these prosocial themes very briefly during intake and gives the family a poster listing the “secrets” to take home. Thereafter, as needed, the therapist uses leading questions to recall a relevant “secret,” and then returns to the task at hand. We have distilled the “seven secrets” from working with families and studying the work of expert clinicians. We provide no scientific references, since the “secrets” represent above all else our personal philosophy about human potential for change.19 1. Know yourself. In happy families, parents and adolescents know who they are and understand their own strength and weaknesses. When confronted with a serious problem, they don’t engage in denial. They don’t glorify problems in self-control. They don’t delude

interview, and in the intervention proper. At sites without research protocols, this is the time for a treatment contract to be signed by family members. This is also a good time for parents to consent to release of information needed for corroboration of community problems. 18 In our longitudinal study, we are looking for the beliefs that distinguish families of resilient juvenile offenders. As we learn more about the expertise of these families we plan to reinvest the new knowledge into refinement of PFT manual components such as the “seven secrets of happy families.” At this point, the “seven secrets” are an amalgam of research information about risk factors and clinical wisdom. 19 During telephone interviews, we collect information about family members’ beliefs that PFT is working. These data prepare us to evaluate consumers’ satisfaction with components of PFT such as the seven secrets.

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TABLE 4. Problems Types, Definitions, and Examples Community Problems Definitions

Examples

Complaints about a child’s behavior received by a parent or guardian from police, school personnel, neighbors, or other credible sources in the community. Parents directly observe child’s problematic community behavior. Behavior that has the potential for jeopardizing others’ safety or happiness is a problem even if the behavior is not illegal.

School reports fighting, ditching, or disrupting class. Sent home due to inappropriate behavior. Neighbor complains child has damaged property or hurt pet. Store personnel accuse or catch child shoplifting. Police warn, cite, or arrest child for illegal behavior. Parents observe child hitchhiking. Parents see child in mall during school hours. Parents see child in possession of illegally obtained items. Parents hear about association with deviant peers.

Home Problems Behaviors that violate reasonable household rules established to safeguard all family members’ safety and happiness. When parents have not established such rules, they may believe that there are no problems at home. In this case, the intake counselor inquires about home problems in this way, “Think about this past week, what things did any of the kids do that caused physical harm or emotional distress to someone in the family.”

Disrespectiful, mean, or abusive behavior to parents or siblings. Neglect of assigned household chores. Whereabouts not known. Staying up past assigned bedtime. Using other family members’ property without permission. Playing with matches or other dangerous household objects. Damaging the house and its contents. Monopolizing telephone, television, or favorite family foods.

Coping Problems Difficulties in self-regulation of emotions and selfcontrol of behavior when alone and when with others. In some cases, at intake, youth will report that they have internalizing problems (e.g., incapacitating fear). Rarely will youth report problems in self-managing externalizing behavior (e.g., smoking cigarettes). Parents can help by talking about what they observe (“my child flies into a rage if I refuse what he wants,” “my child comes home smelling of liquor”). Self-control problems can be defined in terms of either parent observation or child report. (The Good-Day Plan for self-control problems always rewards children for talking once a day to parents about self-control problems such as suicidal feelings rather than merely hiding these feelings).

Unprovoked unhappy behavior and feelings. Uncontrollable crying. Temper tantrum. Self-destructive behavior. Trouble concentrating. Irritable and angry about little things. Unprovoked anxiety, fears, nightmares. Ignores or violates medical doctor’s recommendations. Uses cigarettes, alcohol, or drugs.

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FIGURE 3. Behavior problems displayed as multiple-baseline data. These graphs display the frequency of days per week with an occurrence of one or more relevant problems (“problem day”). Thus, the number of “good days” per week (without any relevant problems) is 7—the total number of problem days. Community problems include police arrest, neighbors’ complaints; home problems include sibling fights and curfew violations; coping problems include temper tantrums and suicidal threats.

themselves about the impact of their behavior on others. They don’t lie to themselves about the extent of their own coping problems. They have boundaries and know the difference between self and others. 2. Treat others as you would like them to treat you. In happy families, parents and children are sensitive to other people’s needs, beliefs, preferences, and lifestyles. They think about how what they say and do will affect other people. Parents repeatedly show

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their children by example that it is a good thing to consider other people’s needs without being irrationally self-sacrificing. Parents in happy families also help their children think before they act. In unhappy families, parents see nothing wrong in children’s misbehavior; they convince themselves that children’s criminal actions are cute or clever or justified by persecution and financial necessity. 3. Respect your elders. In happy families, parents act in ways that earn their children’s respect. Parents in happy families recognize that every adolescent must find his or her own unique destiny and identity. Healthy adolescents do this by questioning people in authority: their parents, their teachers, and the police and by experimenting with behavior that is socially nonconforming but safe for themselves and others. In happy families, parents encourage their adolescent children to debate the moral correctness of the social order and to develop their own preferences in politics, lifestyle, music, and art. But they do everything they can to prevent their teen-aged children from breaking laws designed to protect their own and others’ safety and happiness. In a happy family, parents obey laws designed for the common good and they make it clear that children who break the law hurt their parents as well as their victims. Children in happy families hesitate to break the law since such criminal acts will hurt their parents’ pride, self-esteem, reputation, income, and even their jobs. Every adolescent wants status with their peers and often acts foolishly to make friends. In happy families, respect for parents and for self outweighs the desire for peer acceptance. 4. Care for those who are younger and needier than you. In a democratic society, laws are designed to protect people who are vulnerable. In happy families, parents take good care of their children and are charitable towards needy people outside the family. In this way, children learn from observation that it is a good thing to take care of younger brothers and sisters and to avoid doing harm to younger or otherwise vulnerable people outside the family. In unhappy families, parents may not take good enough care of their children, they may not protect them sufficiently from harm, they may not teach them right from wrong, or they may exploit their children for their own personal gain and pleasure. 5. Face facts. Acknowledgment of need for treatment. In the happiest of families, kids get in trouble. What distinguishes happy families is that parents take seriously wake-up calls from the universe such as a child’s arrest and use the opportunity to get the family working better. The families who get into therapy and finish a prescribed course of therapy are often not the weakest families but the strongest families. Acknowledgment of siblings’ difficulties. In happy families, parents recognize that one child’s problem can affect all siblings. They understand that siblings may be at risk just because the juvenile offender has been the focus of parents’ energies for so long. Siblings may be at risk because: the offender has victimized them for many years; because siblings have been modeling themselves after the offender and following in his or her deviant footsteps; or, because of the same circumstances (e.g., inadequate parental supervision) that led the offender astray. Parents in happy families recognize that even if siblings were not at risk, it would be impossible to reshape the offender’s family environment without the participation of resident siblings. Keeping family secrets. In happy families, parents are appropriately honest with each other and with their children. They don’t needlessly and ineptly try to keep some key events as “secrets.” In unhappy families, deep, dark secrets (either real or imagined) often prevent the family from making any progress in directing energy at current family problems. Sometimes the secret represents a continuing, dangerous circumstance such as

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physical or sexual abuse of children. Until this secret is disclosed and appropriate action taken no family member will be safe. Sometimes the secret represents a fact that is known to all family members but never openly discussed such as a parent’s infidelity. Sometimes the secret represents a fact of life such as the sexual preoccupations of adolescents and the discomfort this poses to their parents. 6. Take responsibility for your actions. In happy families, parents take responsibility for their mistakes, apologize for the impact of their mistakes on others, and get on with life, working toward preventing such errors in the future. Thus, parents in happy families readily take part in family therapy in order to help a child who has been arrested. In unhappy families, parents may be so overwhelmed by the crisis of a child’s arrest or so guilty that they prefer to place the juvenile offender in individual therapy, or send the child away for residential treatment rather than actively take part in family therapy to rebuild family life. Common sense suggests that neither individual therapy nor residential treatment do anything about the family risk factors that maintain vulnerability throughout adolescence. 7. Leave this world a better place that you found it. Parents and children in happy families recognize that life is often not fair. No matter how hard they work they may still not have all the money, power, prestige, or security they want. But they can have unlimited love and self-respect if they make this world a better place for all people.

6. Telephone interview. Clinical staff20 conduct structured telephone interviews at times shown in Table 2. Guided by the family’s own problem definition, parents report on how many days during the past week each child had at least one community problem; at least one home problem; and at least one coping problem (“problem days”). Children report about their own problem days in the past week. In addition, family members rate their daily mood and satisfaction with treatment. Once a Good Day Plan (GDP) has been instituted, they report about plan adherence. In addition, the telephone interviewer periodically collects corroborating information about community problems from extra-familial sources. The telephone interviewer prepares a weekly report containing: (a) problem day graphs (see Figure 3); (b) graphs of mood and treatment satisfaction; (c) information about crises or current GDP glitches; (d) recommendations about current and future GDPs.

7. Multiple-Baseline Design The multiple-baseline design, a single-case experimental design, ensures that change observed in the course of intervention is attributable to intervention and not to other spurious factors such as maturation or seasonal change (Barlow & Hersen, 1984; Lucyshyn, Albin, & Nixon, 1997).21 As Figure 3 shows, telephone interviews yield three-part community,

20 Telephone interviewers are not involved in the PFT meeting as therapists. When the telephone interviewer requests information about satisfaction with treatment, family members may find it easier to provide an honest yet negative report. Others may decide that, for one reason or another, fusion of therapist and telephone interviewer roles is necessary. The telephone interview form is available from the first author. 21 The multiple-baseline design ensures the internal validity of each single-case experiment, strengthening the argument that intervention and nothing else, is responsible for outcome. Internal validity is a precondition for external validity or generalizability. At sites where PFT participants are sampled at random from a known population and PFT is embedded in a group design with random assignment to PFT or to another intervention, the results are likely to have both internal and external validity.

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home, and coping problems problem-day graphs for all siblings.22 Each three-part graph represents a multiple-baseline design.23 Baseline data result from telephone interviews conducted after intake and before institution of a Good-Day Plan (GDP). Graph A of Figure 3 to the left of the vertical line (telephone interviews 1–3) shows that a hypothetical delinquent. Johnny Smith, had 5 to 6 community problem-days a week during baseline. Graph B (telephone interviews 1-6) shows that Johnny had 6 to 7 home problems days a week during baseline. Graph C (telephone interviews 1-9) shows from 4 to 7 coping problem days. Intervention data result from telephone interviews conducted after institution of a Good-Day Plan (GDP), as shown in Figure 3 to the right of the staggered vertical line. The onset of intervention is staggered such that intervention via a GDP occurred earliest in Graph A and latest in Graph B. The first GDP focused only on community problems, the second GDP focused on community and home problems, and the third GDP focused on community, home, and coping problems. The staggered onset of intervention with baseline periods of different lengths (shortest for community problems) gives rise to the name “multiple-baseline design.” During the very same time period (telephone interviews 4–6), we can compare baseline data for home and coping problems with intervention data for community problems. Notice that introduction of the community Good-Day Plan (GDP) is associated with a marked decline in targeted community problems and no decline in home or coping problems. This tells us that the GDP for community problems and not some other circumstance (e.g., change in diet or teacher) is responsible for improvement in community problems. Notice that introduction of the GDP for home problems is associated with a marked decline in targeted home problems, continued success with community problems, yet no decline in coping problems. This tells us that the GDP for community and home problems and not some other circumstance (e.g., therapeutic alliance) is responsible for improvement in home problems. Without multiple-baseline data, therapist and family would be in the dark about the true impact of intervention. Two kinds of false conclusions could be drawn without these data.24 First, we might falsely conclude that PFT is working (when it is not). Families would fail to refine or more effectively implement their plan as necessary, or would mistakenly stay in PFT rather than seek a more effective treatment. Second, we might falsely conclude that GDP is not working (when it really is). Families would drop out prematurely and not benefit from available help.

22

Figure 3 shows a three-part graph for a hypothetical juvenile offender. The telephone interviews yield such graphs for each sibling and an “all sibling” graph showing the number of problem days per week for all siblings combined. During the Discovery Task at the beginning of each PFT meeting, the family examines the all sibling graph. When the offender is an only child, the family looks at a graph like the one in Figure 3. The focus on all siblings is intended to ensure that the Good-Day Plan is implemented similarly for all children. 23 Although it might be ideal for family members to count and report problem-free good days rather than problem incidence, there are several practical obstacles to the former procedure. First, during the three pre-PFT baselines (for community, home, and coping problems), family members have no definition or understanding of a “good day” for the particular problem type. Second, we have designed telephone interviews (and collection of problem incidence data) for administration to families receiving interventions other than PFT that do not involve a good-day system. In fact, once PFT intervention begins, families explicitly count good days as well as problem incidence, so that they can deliver rewards at the end of each good day. 24 These false conclusions correspond to the Type 1 and Type 2 errors that are avoided in inferential statistics by significance tests.

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8. Good-Day Plan To reduce the frequency of problem days, a family designs and implements a series of Good-Day Plans (GDPs). The GDP is a contingency contract that offers all siblings an opportunity to earn desired rewards at the end of a “good day” (a day that is not a problem day). The “C-GDP” rewards days without community problems. The “CH-GDP” rewards days without community or home problems. The “CHC-GDP” rewards days without community, home, or coping problems.

THE PFT MEETING GDPs are designed, evaluated, and fine-tuned during 50-minute-long PFT meetings scheduled in Phases 1 through 3 consistent with the timeline in Table 2. Each PFT meeting is structured, as Table 3 shows, by five tasks ordered as follows: Discovery, Reunion, RolePlay, Plan, Wrap-Up. In Discovery, the family reviews the all-sibling problem-day graph, comparing the past week’s data with data from preceding weeks. In the Reunion, family members take turns talking about problem days and good days and about current GDPs. In the Role-Play, family members act out events from recent problem days and rehearse the current GDP. In the Plan, family members design, troubleshoot, and refine the GDP. In the Wrap-Up, the therapist links recent progress with problem days to new seemingly unrelated family crises.

Rationale: PFT Tasks as a Scaffold for Prosocial Communication at Home At one and the same time, the five PFT tasks are designed to guide the family through resolution of community, home, and coping problems and to promote, rehearse, and maintain prosocial communication skills. Prosocial communication includes three processes shown in Figure 4 that correspond to the PFT tasks. The basis of prosocial communication is information exchange in which we express our point of view and learn about others’ perspectives. Experience with information exchange prepares us for behavior management in which we ask for what we need, persuade others to comply with our reasonable requests, listen to others’ requests, and comply with others’ reasonable requests. Experience with behavior management equips us to problem solve, identifying seeming conflicts between our own and others’ needs. In problem solving, we engage in information exchange and behavior management to develop a mutually acceptable solution. In PFT, Discovery, Reunion, and Wrap-Up Tasks prompt information exchange. The Role-Play Task prompts information exchange and behavior management. The Plan Tasks involves problem solving. Taken together, the PFT tasks act as a scaffold that the family gradually ascends during each PFT meeting providing repeated opportunities to solve problems while rehearsing prosocial communication and coping strategies. It is our expectation that family communication behavior will gradually come under the stimulus control of the PFT tasks, first in the clinic and later at home, until prosocial communication becomes the norm for family interaction (Blechman, Olson, & Hellman, 1976). Our clinical observations to date suggest that changes in communication behavior are at times surprisingly swift.25 As an unintended positive consequence of the PFT tasks, therapists

25 The impact of PFT tasks on family communication is an empirical question that we are currently examining.

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FIGURE 4. Prosocial Family Therapy tasks as scaffolding for prosocial communication.

have an opportunity in each session to observe strengths, weaknesses, and shifts in family communication.

Supplementary PFT Meetings During any PFT phase, at the family’s request, the therapist may schedule supplementary meetings for various purposes: crisis management, coordination of intervention plans across social systems and health-care providers, and specialized skill training. Therapists conduct supplementary meetings relying exclusively on prosocial communication strategies. A family’s attendance at supplementary meetings does not reduce their commitment to attend regularly scheduled PFT meetings. The family’s requests for and attendance at supplementary meetings provides a behavioral index of their receptivity to PFT. 1. The Discovery Task. Regularly scheduled PFT meetings always open with the 5-minute-long Discovery. The Discovery ritualizes a shared family focus on the facts about behavior and an awareness of behavior change. The PFT therapist begins this task-by placing the all sibling problem-day graph in front of family members and providing a rationale. Rationale for the Discovery Task.26 In the intake, you agreed that Jimmy’s arrest for shoplifting is an example of a community problem. You agreed that big “blow-ups” at home where the kids get in “nasty” arguments with each other are an example of home problems. You agreed that when Chico is “bummed out” and “miserable” and hides in his room sniffing glue that is an example of a coping problem. What we’ll do now is discover how many community, home, and coping problem days all you kids had this past week. Let’s look at this graph. Who can tell me what this graph shows us about community problem days since Tuesday?

26

In the first PFT meeting, the therapist uses structuring statements to deliver a rationale for each task that is relevant to family members’ own concerns and is expressed whenever possible in family members’ own words. In later meetings, the therapists uses leading questions to elicit this rationale.

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Discovery Task procedures.27 1. Checking the accuracy of data on the graphs. The therapist checks on the accuracy of graphed data and take steps in the meeting and later to remedy obstacles to accuracy. 2. Understanding graph. The therapist uses prosocial communication strategies shown in Table 1 to ensure that all family members understand what the graph portrays.28 3. Developing a shared perspective about data. The therapist helps the family develop a shared and optimistic perspective about data from the past week as compared to previous data. While the group examines the all-sibling problem-day graph, a factual focus on the combined data ensures that the juvenile offender is not treated any differently than siblings. 4. Drawing implications from data. The therapist uses recent data as the basis for: (a) introduction of a new C-GDP; (b) expansion to a CH-GDP; (c) expansion to a CHCGDP; (d) fine-tuning of a current GDP. 2. The Reunion Task. The 10-minute-long Reunion is the second task in each PFT meeting. The Reunion ritualizes information exchange, a communication process in which family members learn to present their own point of view and understand others’ perspectives. The Reunion provides an opportunity for each family member to vent their feelings and express their thoughts without encountering criticism or undesired advice from therapist or other family members. This task helps families move away from coercing one another to change and towards accepting and appreciating the differences among family members. Difficulties for the therapist. Troubled, unhappy families present a great challenge to novice therapists who constantly want to intervene and save these families from themselves. The Reunion is particularly trying for the beginning therapist who is tempted to stop speakers from saying confrontational things when they have the floor and who is tempted to interpret or reframe confrontational statements at the end of the task. The more experienced therapist sets a tone of acceptance and constraint by remembering that the family has a lot of things to learn about communication from the Reunion.29 Rationale for the reunion. At intake, Dad, you said that nobody ever listens to you or follows the rules you set. You boys said that your Dad is always trying to change you. Now you’ll get a chance to let other people know who you are, and what you think and feel about community problem days. Each of you has exactly 2 minutes to speak. Today, Dad talks first, Johnny second, Cory third. Next time we meet, someone

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Hereafter, the reader should assume that the therapist accomplished all task procedures in every regularly scheduled PFT meeting in each PFT phase. The therapist and the observer certify adherence to these procedures when completing the checklist in Appendix A. 28 Hereafter, the reader should assume that the PFT therapist always relies on prosocial communication strategies shown in Table 1 to accomplish all PFT procedures. 29 Hereafter, the reader should assume that novice PFT therapists would have similar difficulties appreciating and communicating to families the rationale for other PFT tasks and procedures. These difficulties can only be resolved when novice PFT therapists are trained and supervised by experienced PFT therapists. Early in training, we believe that novice therapists should demonstrate their comprehension of the details of all PFT procedures and their mastery (in response to a “devil’s advocate”) of the rationales for all PFT procedures.

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else will go first. Each time you come here, the order will be different so that everyone will have a chance to talk first. While anyone is talking during their turn, all other family members are to remain completely silent and listen carefully, remembering the details of what is being said. No one, including me, will interrupt the speaker. After everybody has had a chance to speak and to listen, we will see how well each of you can remember what the others talked about.

Reunion task procedures. 1. Assigning talk turns. Using randomly ordered lists of family members’ names, the therapist ensures that each person has the same number of chances to speak first in the Reunion. 2. Focus on current problem type. In the Reunion, family members are always asked to talk about the current problem type even though they may choose to move on to another topic. 3. When a speaker is silent. In families characterized by intense conflict, some family members may be reluctant to use their talk time fearing criticism or ridicule. Prior to the first Reunion, the therapist explains that each family member can use all of their talk time as they choose, to talk or be silent or both. During the Reunion, if a family member is silent during talk time, the therapist remains silent and gestures to other family members to remain silent. 4. Timing the speaker. Based upon the number of family members present in the meeting, the therapist makes sure that each has an equal share of talk time. 5. Coping with interruption. Before the Reunion, the therapist prepares all family members to remain silent during others’ talk time and to ignore interruptions when they have the floor. After the Reunion, the therapist acknowledges the family’s efforts to follow these rules. During the Reunion, the therapist remains silent (and out of eye contact) regardless of what a speaker says. If someone interrupts the speaker, the therapist says nothing but gestures to the speaker to keep talking. 6. Family members take turns showing how well they listened. The therapist uses leading questions to elicit and confirm accurate recall by each family member of at least one other family member’s narrative. This means that listener must restate another speaker’s narrative, and the speaker must confirm that the listener “got it right.” Once family members accurately recall each others’ narratives (i.e., verbatim words), the focus shifts to understanding the core message of these narratives (i.e., what the speaker intended to communicate in the listener’s words). 7. Closing on a positive note. The therapist ends by acknowledging the family’s efforts to follow instructions, speak honestly, listen carefully, and understand each other’s perspective. Improvements over previous Reunions are briefly and honestly noted (e.g., “You all seemed to be honest with each other and more thoughtful than ever before about how you presented angry feelings.”). Predictions for future Reunions are briefly suggested (e.g., “I imagine that next time it will be even easier for each of you to listen without interruption to each other.”). 3. The Role-Play Task. The 10-minute-long Role-Play is the third task in each PFT meeting. The Role Play provides the family with an opportunity to enact their current method of coping with problem days and to demonstrate their adherence to the current GDP.30

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Family members may be inaccurate when explaining how they adhere to the GDP, but the family group’s enactment of their adherence is usually more informative. A GDP will not work without family adherence any more than an aspirin will work if not swallowed. Thus the Role Play serves as a “take measure” for

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Rationale for the role-play. In the Reunion, you all talked about community problem days. Now we’ll see what you all are doing about community problem days. Johnny, when I give you the signal to start, please pretend that you have come home after being suspended from school for cursing the teacher. Mother, please pretend that before Johnny came home, you got a call from Johnny’s principal explaining the reason for the suspension.

Role-Play Task procedures. 1. Setting the stage. The therapist assigns parts in the role play to family members that are relevant to the current problem type and to the discussion in the preceding Discovery Task. 2. Stage directions. The therapist asks family members to: (a) “Do what you usually do in this situation (excluding physical violence)”; (b) “Forget that I’m here. No matter what anyone does or says, handle this together just as you would at home”; (c) “Finish the enactment when the buzzer goes off at the end of five minutes. If you finish earlier, begin talking over the Role Play without me until the buzzer sounds.” 3. During the Role Play. The therapist moves out of eye contact and ignores any bids for attention leaving family members to cope with each other as they have done for so long. If possible, the therapist leaves the room to observe through a video monitor and score the Role Play for adherence to the GDP. 4. Reviewing the Role Play. The therapist guides a review of the Role Play. Led by the therapist, family members discuss what they liked about the enactment, what they think could improve in the way the family currently deals with problem days, and (if relevant) how the current GDP could be tuned up in the subsequent Plan Task. Observation of the Role Play informs the therapist about the family’s communication difficulties. Through clarifying statements and leading questions, the therapist illuminates communication patterns that obstruct the family’s achievement of their stated goals. 4. The Plan Task. Once 3 weeks of accurate problem-day data have been collected,31 the 20-minute-long Plan Task becomes the fourth event in each PFT meeting. During each Plan Task the family formulates, refines, revises, or expands a GDP that rewards children for good days. The GDP is successful if parents carry it out as formulated and if it gradually leads to the elimination of harmful problem behavior and the reduction of irritating problem behavior to reasonable levels. From the GDP, parents get a lasting and healthy method of coping with the challenges of childrearing. The GDP also sets limits within which adolescents can safely experiment with behavior that causes no harm to anyone.

the PFT intervention. Families with consistently poor adherence as demonstrated in the Role Play should expect to have consistently poor results. Because the Role Play serves an important information-gathering objective, the therapist does not prime the family by modeling. PFT therapists use prosocial communication strategies, such as structuring statements and leading questions, to ensure that families will not lapse into uncontrollable family arguments during the Role Play. Thus far, the Role Play has brought out the best, not the violent worst, in families. 31 For brevity’s sake, we do not enlarge on all the efforts of the entire PFT team to ensure that reasonably accurate data about community problem occurrence are available by the time of the first PFT meeting.

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Rationale for the Plan Task. In today’s Discovery Task, you all agreed that the boys are having 3 or 4 community-problems days a week. On these days they get in trouble at school and with neighbors. In the Reunion, you shared your different feelings about community problem days. In the Role Play, you enacted how your family deals with these days. When we reviewed the Role Play, you all agreed that you’d like “a better way” of dealing with community problems. Now is your chance to get a better way! Now, we’ll work together to create a “Good-Day Plan” or a “GDP.” Today’s GDP will focus on gradually reducing community problem days. Your new GDP won’t immediately eliminate all community problems. It would be unreasonable to expect kids to suddenly not get in any trouble after having had community problems for so long. Your GDP will be an immediate success. Dad, if you use it as a management tool, sticking to all the details we agree upon today. Once you consistently use the GDP, Dad, you’ll see a gradual reduction in community problem days.

Plan Task procedures. 1. Formulating a GDP: The therapist helps the family formulate details of the GDP as answers to questions posed by the Good-Day Plan Form. In the first Plan Task, the family formulates a C-GDP that rewards all siblings for good days without community problems. In later Plan Tasks, the GDP is expanded to include all siblings’ home problems (CH-GDP) and all siblings’ home and coping problems (CHC-GDP). The therapist also helps them develop clear and realistic goals for short-term success and for expansion of the GDP that are consistent with PFT’s technical criteria for GDP expansion. The therapist encourages expansion of the current GDP when all agree that the following criteria have been met, indicating that the GDP is “working”: (a) Parents have implemented a GDP for at least 3 consecutive weeks; (b) In the therapist’s opinion, the parents have adhered to all terms of the GDP during the most recent week; (c) In the therapist’s opinion, problem-day graphs are accurate; (d) Since implementation of the GDP, the frequency of relevant problem days (e.g., community problems for a C-GDP) have dropped by at least 3 days per week from the highest baseline frequency for that problem type. 2. What defines a “Good Day”?: (a) “Problem days” occur on a day when the reporting parent determines that a child has had one or more relevant problems (as defined in current telephone interviews) based on written or spoken complaints from police, teachers, neighbors, or other credible adult informants. (b) “Good days” occur whenever it is not a problem day. (c) “Good weeks” occur when all siblings have had 5 or more good days in the preceding work. 3. When do parents declare a good day?: The therapist clarifies the time and place each day when parents will determine if this has been a problem day or a good day, and when they will provide rewards earned for good days. The therapist also clarifies the details for declaring and rewarding a good work. 4. What do children earn at the end of a good day and a good week?: (a) Daily and weekly reward menus: In the first Plan Task, the therapist guides the family in the formulation of a daily and a weekly reward menu. In later Plan Tasks, the therapist guides the family through necessary menu revision. Menus include only those items that parents are willing and able to dispense contingently (only when earned). The family’s daily reward menu includes at least five events, activities, or commodities valued by each sibling from which each child picks one item at the end of a good day. The family’s weekly reward menu includes at least five group rewards from which siblings choose one item at the end of a good week. (b) Contingent reinforcement: The

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GDP will not work if parents freely dispense items on the reward menus that children have not earned via a good day. The therapist helps parents understand the importance of contingent reinforcement of good days and act accordingly. The therapist also helps parents understand the need for noncontingent affection for the child in the context of contingent reinforcement. (“I love you as a person but you didn’t have a good day today and didn’t earn a choice from the reward menu. Remember, tomorrow is another day.”). (c) Emphasizing activities and events in reward menus: The most successful regard menus include numerous items that provide children with access to parents’ and siblings’ attention, interest, and company. Because kids tire of commodities such as candy, and because kids can get money through illegal activities outside the home, favorite social activities at home and with family members are the most long-lasting and healthy items for the reward menu. Therapists help the family identify activity rewards particularly in families that rarely engage in pleasurable activities together. (d) Monetary rewards: Only when parents are willing and able to pay children a small amount of money at the end of a good day (or at the end of a good week) should money be included in the menu. If parents include money, this should be in lieu of an allowance and should be dispensed only when earned by a good day. Parents need to understand that when the GDP is working well, children may eventually earn the right to choose any monetary item in the daily menu every single day. It may, therefore, be a better idea to have a monetary payoff in the weekly menu. Since there is good reason for concern that troubled adolescents will use cash to buy cigarettes, alcohol, drugs, or weapons, it may be preferable to put commodities on the menus that children say they will buy if they earn money (e.g., tickets to movies or sports events, clothing). When children desire an extremely expensive reward (e.g., a new bike) that parents are willing and able to include on the menu, the purchase price of the reward should be divided into small weekly units that seem reasonable to parents and therapist. At the end of a good week, for example, a child might earn a note worth $10 toward a new bike. With such arrangements, the therapist carefully reviews bookkeeping procedures to prevent questions about cheating or unfairness. 5. Tips for a successful GDP: The therapist guides family members, particularly parents, through these tips: (a) Achieving a good day is an uphill battle for children with behavior problems. Do expect more problem days than good days. Savor every good day and they will come more and more often. (b) Do know the difference between a good day and a problem day. (c) Do dispense reward menu items only when earned by good days or good weeks. (d) Do load up reward menus with as many desirable items as you can dispense. The more appetizing the reward menu, the more children will stop and think before giving in to the temptations that lead to problem days. (e) Do respond in a patient, quiet, and nonjudgmental manner when you determine that a particular day is a problem day. When children beg for reward menu items at the end of a problem day, do repeatedly make the following statement (until they get the idea), “Tomorrow is another day.” (f) Do remember that your children are even more disappointed than you are at the end of a problem day. Remember, they are losing out on their favorite reward menu items. Criticizing children for problem days discourages them from any effort to have a good day. (g) Do understand that your children are already suffering the natural and punitive consequences of their own actions by the time you have been notified about community problems. If someone reports a community problem to you and asks you to take action, indicate that you already are taking action. Do understand how adding punishments to the GDP will sabotage success.

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6. Revising the GDP: In the course of the Discovery, Reunion, and Role Play Tasks, “glitches” in the GDP inevitably emerge. These glitches become the focus of the subsequent Plan Task. The therapist helps the family view glitches in an optimistic manner as a basis for improvement in the GDP and recycles through the Plan Task procedures listed above. 7. Expanding the GDP to include coping problems: Coping problems involve observable manifestations of children’s struggles to manage their emotions and impulses in ageappropriate and safe ways. By the time a family has expanded their GDP to include coping problems, they have already had considerable success with community and home problems. These successes prepare the family to tackle more sensitive coping problems. The GDP for coping problems is intended to reward youth for days free from observable and unhealthy coping strategies. It is absolutely not the purpose of the coping GDP to suppress a safe public display or discussion of distressing emotions, experiences, or impulses. The GDP should not reward children for denying their feelings or lying about their feelings to others. The GDP should reward children for days when youth limit public evidence of coping problems to discussions of these problems with parents, siblings, and other appropriate adults (e.g., a therapist) and to activities that provide youth with help in their coping efforts (e.g., attendance at a teen peer-counseling group). Success of the coping GDP requires that parents not become frightened when children talk to them about their coping difficulties and that parents reward children’s prosocial coping efforts with exceedingly good listening. Children are most likely to learn to put their feelings into words (rather than into dangerous actions) once parents learn to listen without interruption, panic, judgment, or gratuitous advice. Of all the GDPs discussed so far, the coping GDP provides the greatest opportunity for children and parents to learn self-control, coping, and communications skills. Criteria for a coping good day. The two criteria for a coping good day are: (a) The child engaged in no unsafe displays of coping problems (e.g., no coming home drunk, no suicidal threats, no threats of violence against others, no binge eating), and (b) The child took part in a “coping discussion” focusing on “how I coped with my feelings today” for at least 5 minutes. The length of the coping discussion should depend upon children’s wishes. At the dinner table, all children in the family might take turns talking about today’s coping efforts so that each one gets at least 5 minutes of talk time. These coping discussions should take place daily (and are a daily criterion for a coping good day) whether or not the child has reported coping problems. 5. The Wrap-Up Task. The 5-minute-long Wrap-up Task concludes each PFT meeting. Wrap-up provides family members with a time to discuss any crises that occurred during the preceding week and to discuss important topics unrelated to the current GDP. Wrapup allows the therapist to conclude each PFT meeting on an optimistic note, linking progress on the current GDP to other topics of concern to the family. Rationale for the Wrap-Up Task. The therapist introduces the Wrap-up by explaining that during this time family members can bring up any topic that is important to them even if it is unrelated to the current GDP. Wrap-Up Task procedures. 1. Presentation: The therapist ensures that family members have enough time to raise emergency and crisis concerns.

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2. Action: When the therapist feels that family members need extra help right away with these concerns, help that is not available to them elsewhere, the therapist offers to schedule supplementary meetings. When the therapist feels that nothing can be done about these concerns (other than accept their reality), the therapist clarifies this perspective. When the therapist feels that the family can adequately deal on their own with these concerns, the therapist clarifies this perspective. 3. Close: The therapist closes every meeting with a genuine, optimistic affirmation of the accomplishments of each family member and of the whole family. DISCUSSION In this brief discussion, we consider two quasi-philosophical issues related to the treatment of delinquents and their multiproblem families.

Family Preservation We do not believe that family preservation per se should be the ultimate goal of services for high-risk youth, juvenile offenders, and their families. We are all for attempts to preserve family structure while changing family process. We are convinced that methods such as PFT will prove useful with families headed by biological or foster parents who evidence genuine, consistent concern for their children’s welfare. We question whether any contemporary method can change (in the time needed to support the development of a high-risk youth) abusive, rejecting, narcissistic parents who have consistently ignored their children’s well-being.

Therapeutic Acceptance We believe that acceptance of reality is a precondition for behavior change among highrisk youth. A high-risk youth’s acceptance of reality begins with acknowledgement of parents’ limitations. Unrealistic attempts by family therapists to preserve the family’s structure or to engage an unwilling biological parent in therapy make it harder for youth to relinquish antisocial and self-destructive behavior as a means of managing an unpredictable world. Rather than forcing reluctant parents to become involved in PFT, we prefer to implement PFT with willing and able foster parents, house parents, teachers, or community mentors. Thus, a community mentor could participate in all Phase 1 PFT meetings (with occasional involvement by a biological parent) and administer the daily and weekly goodday plans. A year later, during Phase 2, the biological parent might be ready to share in the work with the community mentor, administering weekly rewards. A year later, during Phase 3, the biological parent might be ready to assume complete responsibility for goodday plans with occasional support from the mentor. Acknowledgments—Preparation of this article was partly supported by NIDA Grant 1-K01-DA-00316 to the first author. We thank Boulder County District Attorney, Alex Hunter, Assistant DA, Phil Miller, and Juvenile Diversion Coordinators Jim Kennedy and Patty Baker for their support in the ongoing development and evaluation of Prosocial Family Therapy. We also thank Howard Mabry for suggestions that gave rise to the WrapUp Task and for adaptation of PFT for home-based interventions with inner-city AfricanAmerican youth in Washington, DC; Nancy Horstmann, our clinical director, for her supervision of trainees and pretesting of PFT methods; Colleen Coffey and Amy Helstrom for their editorial assistance; and Pam Mills for her contributions to manuscript prepara-

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tion. In addition, we thank Alan Gurman, Lizette Peterson, and two anonymous reviewers for their thoughtful critiques.

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APPENDIX A

APPENDIX B GLOSSARY OF ABBREVIATIONS AND TERMS C-GDP: Community GDP. Usually the family’s first GDP. CH-GDP: Community and Home GDP. Usually the family’s second GDP. CHC-GDP: Community and Home and Coping GDP. Usually the family’s third GDP. Contingent reinforcement: Parents dispense reward menu items only when earned by their children via a good day or good week as specified in the current GDP. Current problem type: Type of problem focused on by current GDP. GDP: Good-Day Plan. Good day: A day when the reporting parent determines that a child has no relevant problems (as defined in current telephone interviews). Good week: A week in which all siblings have had 5 or more good days. Multiple-baseline design: As shown in Figure 3, intervention, in the form of an expanding

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GDP, is introduced sequentially across community, home, and coping problems. The baseline for successive problem types is increasingly longer giving rise to the design’s name. PFT: Prosocial Family Therapy. Problem day: A day when the reporting parent determines that a child has had one or more relevant problems (as defined in current telephone interviews). Problem-day graph: Graph like the one shown in Figure 3 that displays the number of days per week with one or more problems of the current problem type. Prosocial communication: Communication strategies listed and defined in Table 1.