Research Plenary

Peter Fraenkel

Murder. Assault. Rape. Armed robbery. Car theft. Arson. Drug abuse. Disorderly conduct. Once mostly the province of adults, the perpetrators of these extreme acts are increasingly teens, even children. Consider the following alarming statistics:

• Juvenile arrest rates for disorderly conduct doubled between 1984 and 1996
• Juvenile arrest rates for weapons law violations followed a pattern similar to murder arrests, doubling between 1987 and 1993
• The juvenile arrest rate for aggravated assault increased steadily between 1983 and 1994, up more than 120%

In other words, more kids are acting more violently than ever before.

We all pay for these crimes. In addition to the pain and suffering of the victims and their families, the suffering and confusion of the youth who perpetrate the violence, and of their families, can be enormous. And when violent acts in a particular community reach the national consciousness through the media -- as in the shootings this year at a Colorado high school - the terror spreads and the acts may be replicated by other troubled youth.

In a fair number of cases, violent kids are also abusing drugs or alcohol, a marker of their unhappiness. Consider this additional fact: after more than a decade of stability, the juvenile arrest rate for drug abuse violations increased more than 70% between 1993 and 1997.

Often, as in the case of Columbine, the early warning signs of a youth in trouble are missed or ignored. Once the youth acts violently, the courts and social services system often mandate him (or her) to a residential facility. Many such facilities have no real treatment. Those group programs that have received the greatest attention (mostly involving ordeals of the "scared straight" variety) have been found not effective. Individual and family therapy approaches not specifically designed to address the particular needs of this population also have been found ineffective. In particular, these young people and their families often expect (and sometimes receive) negative, judgmental treatment at the hands of those attempting to provide care. Parents may be reluctant to come into treatment because they fear being blamed for a situation they feel they cannot control. Or, they may not wish to come in because there is something to hide: domestic violence, child abuse, and chronic alcoholism.

Although some in our field still question the usefulness of clinical research, most would probably agree that when it comes to juvenile violence and drug abuse, it would be good to know which approaches, if any, are effective and which are not. With such problems, effective versus ineffective treatment may literally have life or death consequences.

Jim Alexander, recipient of AFTA's 1986 award for distinguished contributions to family therapy research, as well as numerous other awards and federal grants, has dedicated much of his professional career to carefully developing and testing a comprehensive form of family therapy that addresses the complex mix of difficulties experienced by juvenile delinquent youth and their families. His approach, Functional Family Therapy, has been designated one of two Family Based Empirically Supported Treatments (FBESTS) that are effective and reproducible with families representing a wide range of cultures, ethnicities, rural and urban living contexts, family forms, socioeconomic levels, and primary languages. FFT has been identified as an "Exemplary Program" by the Office of Juvenile Justice and Delinquency Prevention and as a "Best Practice" by such organizations as the Center for Disease Control's Violence Prevention Communication Plan, and the Center for Substance Abuse Prevention.

In contrast to many alternative approaches that focus on pathology and feature confrontational methods, FFT's core philosophy is one of forging connection, providing support, building motivation and hope, locating positive aspects of individuals and families, and strengthening resilience. The approach works to link families to community resources that can help them sustain change. And unlike some manualized, research-based treatments that may apply the same techniques in the same way to all families, Jim's approach is tailored to work with the particular context, challenges, resources, culture, values, and capacities of each particular family. Thus, it combines the best aspects of a replicable, researchable treatment with attention to the particular meaning system of each family.

If there wasn't plenty of research showing that practitioners other than Jim can be effective using FFT, I'd have guessed that the most powerful active ingredient of the treatment was Jim himself. In my first phone call with him several months ago to plan the plenary, I was almost knocked over by his personal warmth as it flowed out from over the phone lines from Utah, where he is a professor of psychology. The effect lingered for days! I could barely recover my cynical New York self by the end of the week; in fact, I never did. With all his accomplishments, Jim is one of the most down to earth and gracious people you'll ever meet.

Speaking of great human beings, there's Dan Santisteban, our second distinguished presenter. Dan and I met as clinical psychology interns at Bellevue Hospital in New York City in the late 1980s. From the beginning, Dan seemed to me to wonderfully combine being an empathic, warm, and creative therapist with a tremendous intellectual curiosity about what actually works in psychotherapy. As everyone knew he would, Dan went on from internship days to become one of the most talented researcher-clinicians in the field. Like Jim, he, along with his colleagues José Szapocznik and others at the University of Miami School of Medicine Center for Family Studies, has focused on high-risk youth involved in serious misconduct and drug abuse, especially Hispanic teens and their families. Prompted in part by some of the team's findings that revealed differences in treatment engagement for Cuban versus other Hispanic families, Dan is now breaking new ground systemically exploring the role of immigration, acculturation, and ethnicity in family processes and therapy effectiveness. He approaches this work not by specifying so-called "characteristic issues" of particular groups, but much more complexly - identifying the multiple dimensions of values and behavior that intersect in particular ways for particular families within particular cultures and groups. Dan is currently Research Associate Professor of Psychiatry and Behavioral Sciences, and is a Principal Investigator on two studies working with borderline and suicidal adolescents and their families, as well as having served as Co-Principal Investigator on a number of other studies.

After many years of staying in touch only by occasional phone call and email, I had the good fortune to be in Miami for a conference six months ago, so Dan and I got together to talk about "old times" and our current challenges. I shared some tricky dilemmas facing me in a study I'm conducting; Dan listened carefully and in his usual style, got right to the heart of the matter and helped me resolve the issues. I remember having a flash of a thought that I wish I'd had a mentor like Dan when I started this study. Later, Dan spoke about his real passion - teaching and supervising young clinicians working with the youth to whom he's dedicated. "I love it - just love it." That sums up Dan Santisteban - passionate, thoughtful, and creative.

We are still in process of finalizing the discussant(s) for this year's AFTA Research Plenary, but anticipate an added treat. This plenary is sure to provide us with a view of some of the best of what research in our field can be about - a focus on developing interventions on issues with implications for individuals, families, and communities, a combination of scientific rigor and respect for diversity, passion and thoughtfulness.

Peter Fraenkel is an Associate Professor of Psychology at The City University of New York, and Director of the Center for Time, Work, and the Family at The Ackerman Institute. His current research activities center on collaborative development of family support programs for homeless families in transition from welfare to work, the impact of relationship-strengthening programs on health, and temporal issues in family life. As Chair of AFTA's Research Committee, his goal is to host conversations among researchers, clinicians, and community program developers that erase boundaries and link us in the common purpose of assisting all forms of families to thrive.