Faculty Bibliography

This study introduces an observational measure of fidelity in evidence-based practices for adolescent substance abuse treatment. The Therapist Behavior Rating Scale-Competence (TBRS-C) measures adherence and competence in individual cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse. The TBRS-C assesses fidelity to the core therapeutic goals of each approach and also contains global ratings of therapist competence. Study participants were 136 clinically referred adolescents and their families observed in 437 treatment sessions. The TBRS-C demonstrated strong interrater reliability for goal-specific ratings of treatment adherence, and modest reliability for goal-specific and global ratings of therapist competence, evidence of construct validity, and discriminant validity with an observational measure of therapeutic alliance. The utility of the TBRS-C for evaluating treatment fidelity in field settings is discussed

Children and families constitute an ever-increasing culturally diverse group in this country. Together with incentives in multicultural education and the evidence of the impact of different cultural values in the media, these groups have become more visible, more complex, and harder to study. Culture is defined as dynamic and expressive of shared values and behaviors. Cultural patterns may be situation specific and change according to contextual demands (rural versus urban youth) or may be population specific (the culture of gay youth versus heterosexual youth). Some people also ascribe to cultural beliefs, but these do not necessarily translate to behaviors. Families and their children vary in their level of acculturation and developmentally vary in their level of ethnic identification. Child-rearing patterns and parenting approaches are constantly in flux, as are gender roles and, increasingly, religious affiliations. Clinicians are challenged to treat these families and often find the cultural dissonance with their own native culture and theoretical approaches as obstacles for the appropriate assessment and treatment interventions. As the field of family therapy has developed, so have culturally sensitive and competent approaches in the field of mental health. These approaches must be integrated into the multiplicity of other factors that define normality and psychopathology and be studied further in the context of their relevance and efficacy for special groups of children and families who suffer with specific disorders. In the meantime, cultural awareness and competence will continue to help clinicians understand better the impact of values and patterns in family cycles, family organization, child-rearing practices, and the expression of symptoms in family systems.

Codependence treatment is considered in relation to the cultural narrative embedded in the concept and in light of the values, particularly those of family orientation, characteristic of the poor Hispanic population. Case examples illustrate the need to review the codependence model in sociocultural terms for effective use with poor Hispanic clients