Family mode deactivation therapy in a residential setting: Treating adolescents with conduct disorder and multi-axial diagnosis.

Mode Deactivation Therapy (MDT) has been shown to be an effective treatment for a variety of adolescent disorders (Apsche, Bass & Siv, 2006) including emotional dysregulation (Apsche & WardBailey, 2004) behavioral dysregulation (Apsche, Bass & Murphy, 2006), physical aggression (Apsche, Bass & Houston,2007), sexual aggression (Apsche, Bass, Jennings, Murphy, Hunter & Siv, 2005), and many harmful symptoms of anxiety and traumatic stress, (Apsche & Bass, 2006). MDT Family Therapy has been effective in reducing family disharmony in case studies (Apsche & Ward, 2004), and has been shown to be efficacious as compared to treatment as usual (TAU) in treating families with a variety of problem behaviors (Apsche & Bass,2006) and in reducing and maintaining treatment effects through two years of tracking recidivism rates (Apsche, Bass & Houston,2007). The nature of the pediatric behavioral health industry poses a challenge for treatment research--adequate sample sizes are not always available, and the organizations themselves are generally hostile to active research. The requirement for a control group is often viewed as a human rights concern in this population (often mandated to participate in treatment), and the resistance of the clients and families, although normative, demands that the clinician researcher find a strategy to motivate them to work hard to address their problems. These concerns have prompted us to use "treatment as usual" as the control group, with all of the problems inherent in this practice. We completed a Family MDT clinical study of fourteen adolescents who evidenced problems such as sexual and physical aggression as well as oppositional behaviors including verbal aggression (Apsche & Bass,2006). The results indicated that MDT out performed treatment-as-usual. At the eighteenth month of observation the MDT group has zero incidents of sexual recidivism, while the TAU group had ten reported incidents. The MDT group reported three incidents of physical aggression while the TAU group reported twelve incidents. The results were promising for MDT as a family therapy, and indicate that further study with a larger group should be pursued (Apsche, Bass & Siv,2006). A study of outpatient Family MDT (Apsche, Bass, & Houston,2007) was also completed comparing an MDT group and a separate TAU group. This study examined physically aggressive youth with conduct problems and characteristics of personality disorder. A total of fifteen families were studied--eight in the MDT group, and seven in the TAU group. MDT surpassed TAU at the twenty week interval of treatment. The most compelling point of data was that the MDT group had no referrals for out of home placement, while the TAU group had seven. The results show potential for this population, although the small number of participants limits the claims of efficacy for Family MDT (Apsche, Bass, & Houston,2007). Treatment Paradigm Many Cognitive Behavioral therapists have attempted to identify and address both distorted schemas and maladaptive behavior patterns in family interactions (Dattilio, Epstein, & Baucom, 1998). According to Dattilio, et. al.(1998), Cognitive Behavioral therapists interview the family to determine perceptions of the family and how things operate in the home environment. In addition, the Cognitive Behavioral family therapists view the entire family as a case, avoiding the stigma of one identifying one patient or client. Epstein (1996) found that negative exchanges by family members increase the overall family distress. Dattilio, et al. suggested that the Cognitive Behavioral family therapist pays attention to the antagonistic exchanges between individual family members. Dattilio, et. al. (1998), further suggested that the Cognitive Behavioral family Therapists are attentive to the frequencies and patterns of antagonistic/discordant behavior exchanges; expressive and listening skills for communicating thoughts and feelings; and problems solving skills. …