For Troubled Teens, Group Therapy May Be The Problem; Family Therapy the Solution

Treating a delinquent teen alongside like-minded youths is the norm, but it may exacerbate conduct disorders, according to José Szapocznik, Ph.D., professor of psychiatry and behavioral sciences at the University of Miami School of Medicine. "When kids are alone together, they court each other's anti-social behavior. 'I smoke marijuana,' says one kid. The other says, 'That's great: I know where to buy it.'"

There is no shortage of evidence that destructive behavior can be socially reinforced, a phenomenon hardly confined to teens. (The APA Monitor on Psychology recently documented patients with anorexia and bulimia sharing starvation tips with one another during treatment.)

Szapocznik thinks he has a better alternative for troubled teens: In Evidence-Based Psychotherapies for Children and Adolescents, a book published this summer by Guilford Publications, he argues for a short round of therapy in which the entire family receives counseling once a week for eight to 12 weeks. This targets the entire family, using the premise that the behavior of any one member-in this case, the adolescent-can only be understood by examining the context or family "system" in which it occurs.

When Szapocznik compared 317 adolescents in either brief, strategic family therapy or in group outpatient treatment, he found that 27 percent of youths with conduct disorder showed improvement with the family-centered approach, but there was no improvement among those who received conventional treatment. Almost half the adolescents in treatment for marijuana abuse improved with brief strategic family therapy, as opposed to 17 percent in group therapy. Teenagers in treatment for social aggression proved the most resistant to either therapy, but even they benefited more from the family-focused approach.

So why does group therapy remain the gold standard? "Group counseling is driven by economics," says Szapocznik. "It has a better return because several patients can be charged at the same time."

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