Brief Strategic Family Therapy®
BSFT® is an evidence-based family therapy program that empowers families to break negative cycles, strengthen relationships, and support positive youth development. Extensively studied with African American and Hispanic families, it has proven to increase engagement, enhance family functioning, and reduce substance use and delinquency—creating lasting change for stronger, healthier futures.
About BSFT
Brief Strategic Family Therapy® (BSFT®) is an effective, problem focused, and practical approach to the elimination of substance abuse risk factors. It successfully reduces problem behaviors in children and adolescents 6 to 17 years old and strengthens their families.
The BSFT® Program provides families with tools to decrease individual and family risk factors through focused interventions that improve problematic family relations and skill-building strategies that strengthen families.
The program fosters parental leadership, appropriate parental involvement, mutual support among parenting figures, family communication, problem solving, clear rules and consequences, nurturing, and shared responsibility for family problems. In addition, the program provides specialized outreach strategies to bring families into therapy.
BSFT targets:
- Conduct problems
- Associations with antisocial peers
- Early substance use
- Problematic family relations
The BSFT® Program can be implemented in a variety of settings, including community social services agencies, mental health clinics, health agencies, and family clinics. The BSFT® Program is delivered in 16 weekly sessions. The family and the BSFT® Program therapist meet either in the program office or the family’s home. There are four important BSFT® Program steps:
- Step 1: Development of a therapeutic alliance with each family member and with the family as a whole is essential for the BSFT® Program. This requires therapists to accept and demonstrate respect for each individual family member and the family as a whole.
- Step 2: Diagnose family strengths and problem relations. Emphasis is on family relations that are supportive and problem relations that affect youths’ behaviors or interfere with parental figures’ ability to correct those behaviors.
- Step 3: Develop a change strategy to capitalize on strengths and correct problematic family relations, thereby increasing family competence. In the BSFT® Program, the therapist is plan and problem-focused, direction-oriented (i.e., moving from problematic to competent interactions), and practical.
- Step 4: Implement change strategies and reinforce family behaviors that sustain new levels of family competence. Important change strategies include reframing to change the meaning of interactions; changing alliances and shifting interpersonal boundaries; building conflict resolution skills; and providing parenting guidance and coaching.
- Reduces youth behavior problems, substance use, and association with antisocial peers
- Successfully engages and retains youth and families in treatment
- Increases parental involvement and develops more positive and effective parenting
- Makes parental management of children’s behavior more effective
- Improves family cohesiveness and collaboration
- Improves family communication, conflict resolution, and problem-solving skills
The BSFT® Program was developed by a team of researchers led by José Szapocznik, Ph.D. and Olga Hervis, M.S.W. at the Center for Family Studies, University of Miami. The Center for Family Studies is the nation’s oldest and most prominent center for development and testing of minority family therapy interventions for prevention and treatment of adolescent substance abuse and related behavior problems.
Dr. Szapocznik is an internationally known expert on families and family-based interventions. A professor of Psychiatry and Behavioral Sciences, Psychology, and Educational Research and Counseling Psychology, he is also director of the Spanish Family Guidance Center and the Center for Family Studies, all at the University of Miami. Dr. Szapocznik received the 2000 Presidential Award for “Contributions to the Development of Family-Based Interventions” from the Society for Prevention Research, and, in 1999, received the first ever Research Award from the Center for Substance Abuse Prevention.
The Brief Strategic Family Therapy® Institute Model Managers offer an unparalleled depth and range of experiences with regard to their higher education, certification, licensure, professional experience, publications, funded research performed, honors and awards, editorial responsibilities, professional and honorary organizations, professional associations, teaching, invited and key note presentations, and community services. Our model managers have implemented programs all over the world including but not limited to the United States, Sweden, and Chile.
Implementing BSFT
Trained therapists who can implement the program as tested are required for successful replication. The ideal therapist has a master’s degree in social work, marriage and family therapy, psychology, or a related field. One full-time therapist can provide the BSFT® Program to 15 to 20 families for in-office sessions and 10 to 12 families for in-home sessions. The typical youth and his/her family are treated to completion in four months.
Administrative Support is key to successful BSFT® Program replication. The BSFT® Program requires an agency that is open at times that are convenient for participating families, provides transportation and, if needed, provides childcare when sessions are conducted in the office.
Training and Technical Assistance is available through the Brief Strategic Family Therapy® Institute. The Institute provides a broad range of training programs in Miami or will train onsite at agencies around the country and world. Training is tailored to agency needs and populations and offered in English and Spanish.
The BSFT® Program workshops are only part of the ongoing training commitment that Brief Strategic Family Therapy® Institute makes to the agencies, clinics and therapists that it trains.
In training therapists to competency, workshops then ongoing supervision and review and fidelity ratings are required to gain BSFT® Program site licensing. Prior to launching the workshops, a site readiness process is implemented to evaluate and prepare the site for integrating the BSFT® Program into their organization and current working methods.
If conditions are met, the training program begins with three three-day workshops including interactive lectures, videotape demonstrations and clinical case consultations, plus weekly supervision of the BSFT® therapists.
Workshops consist of:
- Interactive Lectures
- Case Presentations (videos)
- Live family sessions
BSFT® Program training curriculum is comprehensively manualized. The proprietary manual is available to organizations who agree and commit to training, supervision and licensure.
Research
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Engagement and Treatment Retention
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Behavioral and Emotional Outcomes
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Drug Use Outcomes
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Family Functioning Outcomes
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References
The efficacy of BSFT in engaging and retaining families in treatment has been tested in multiple studies, particularly with Hispanic families and adolescents exhibiting behavioral and drug-related issues.
Key Findings:
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Higher Engagement Rates:
- Szapocznik et al. (1988): 93% of families in BSFT engaged in treatment vs. 42% in the control group.
- Santisteban et al. (1996): 81% engagement in BSFT vs. 60% in control conditions.
- Coatsworth et al. (2001): 81% engagement in BSFT vs. 61% in the community control group.
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Higher Treatment Completion Rates:
- Szapocznik et al. (1988): 75% of BSFT families completed treatment vs. 25% in the control group.
- Coatsworth et al. (2001): 71% completion for BSFT vs. 42% for community-based treatment.
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Effectiveness in Large-Scale Study:
- Robbins et al. (2010):
- Families in treatment-as-usual were 2.33 times more likely to fail engagement.
- Families in treatment-as-usual were 1.41 times more likely to fail retention.
- BSFT families attended 9.5 sessions on average vs. 6 sessions in treatment-as-usual.
- Robbins et al. (2010):
BSFT has been found to effectively reduce behavioral and emotional problems in youth, with sustained benefits over time.
Key Findings:
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Comparable to Individual Psychodynamic Therapy & Superior to Recreational Control:
- Szapocznik et al.: BSFT was as effective as psychodynamic therapy and superior to recreational control in reducing behavioral and emotional problems.
- Improvements were maintained one year after treatment.
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Long-Term Benefits for Family Functioning:
- At a one-year follow-up, families in BSFT showed significant improvement in family interactions.
- In contrast, families in individual psychodynamic therapy showed deterioration in family functioning over time.
BSFT has demonstrated effectiveness in reducing conduct problems, antisocial peer associations, and substance use.
Key Findings:
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Reduction in Conduct Problems & Substance Use:
- Santisteban et al. (2003):
- BSFT significantly reduced conduct problems, antisocial peer associations, and marijuana use.
- In contrast, group counseling led to worsened outcomes in these areas.
- Santisteban et al. (2003):
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Long-Term Impact on Delinquency & Drug Use:
- Robbins et al. (2010):
- BSFT significantly improved family functioning compared to treatment as usual.
- Drug use reduction was evident at the 12-month follow-up and was linked to therapist adherence to the model.
- Horigian et al. (2015) 5-year follow-up:
- Significant reduction in delinquent behavior and re-arrests among BSFT participants.
- Robbins et al. (2010):
BSFT is designed to improve family relationships, which in turn enhances youth behavior and long-term outcomes.
Key Findings:
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Improvements in Family Dynamics:
- Szapocznik et al.:
- BSFT led to significant improvements in family interactions.
- Individual psychodynamic therapy resulted in deteriorating family relationships.
- Szapocznik et al.:
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Better Outcomes Compared to Group Therapy:
- Santisteban et al. (2003):
- BSFT significantly improved observer-rated family functioning.
- Group counseling was associated with worsened family relationships.
- Santisteban et al. (2003):
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Effectiveness Across Ethnic Groups:
- Robbins et al. (2010):
- BSFT outperformed treatment-as-usual in improving family functioning for African American, Hispanic, and White families.
- Robbins et al. (2010):
Horigian, V.E., M.S., Feaster, D.J., Robbins, M.S., Brincks, A.M., Ucha, J., Cuccinelli, M.J., Szapocznik, J., & Rohrbaugh, M.J., (2015). A Cross-sectional Asse3ssment of the Long Term Effects of Brief Strategic Family Therapy for Adolescent Substance Use. The American Journal on Addictions, 24: 637-645.
Robbins, M.S., Feaster, D.J., Horigian, V.E., Cuccinelli, M.J., Szapocznik, J., & Henderson, C. (2011). Therapist adherence in Brief Strategic Family Therapy for Adolescent drug abusers. American Psychological Association, 79, 43-53.
Robbins, M.S., Szapocznik, J., Horigian, V.E., Feaster, D.J., Puccinelli, M., Jacobs, P., Burlew, K., Westlein, R., Bachrach, K., & Brigham, G. (2009). Brief strategic family therapy™ for adolescent drug abusers: A multi-site effectiveness study. Contemporary Clinical Trials, 30, 269- 278.
Briones, E., Robbins, M.S., & Szapocznik, J. (2008). Brief Strategic Family Therapy: Engagement and treatment. Alcoholism Treatment Quarterly, 26, 81-103.
Nickel, M. et al. (2006). Influence of family therapy on bullying behaviour, cortisol secretion, anger, and quality of life in bullying male adolescents: A randomized, prospective, controlled study. Canadian Journal of Psychiatry, 51, 355-362.
Nickel, M., et al. (2006). Bullying girls – Changes after Brief Strategic Family Therapy: A randomized, prospective, controlled trial with one-year follow-up. Psychotherapy and Psychosomatics, 75, 47-55.
Horigian, V., Robbins, M.S., & Szapocznik, J. (2004). Brief Strategic Family Therapy. Brief Strategic and Systemic Therapy: European Review [inaugural issue] 1, 251-271. Santisteban, D.A., Coatsworth, J.D., Perez Vidal, A., Kurtines, W.M., Schwartz, S.J., LaPerriere, A., & Szapocznik, J. (2003). The efficacy of Brief Strategic Family Therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17 (1), 121-133.
Szapocznik, J., Hervis, O.E., & Schwartz, S. (2003). Brief Strategic Family Therapy for adolescent drug abuse. [NIH publication no. 03-4751; NIDA Therapy Manuals for Drug Addiction Series]. Rockville, Maryland: National Institute on Drug Abuse.
Robbins, M.S., Mitrani, V.B., Zarate, M., Perez, G., Coatsworth, J.D. & Szapocznik, J. (2002). Change processes in family therapy with Hispanic adolescents. Hispanic Journal of Behavioral Sciences 24, 505-519.
Robbins, M.S., Bachrach, K., & Szapocznik, J. (2002). Bridging the research-practice gap in adolescent substance abuse treatment: The case of Brief Strategic Family Therapy. Journal of Substance Abuse Treatment, 23, 123-132.
Coatsworth, J.D., Santisteban, D.A., McBride, C., Szapocznik, J. (2001). Brief Strategic Family Therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40, 313-332. Robbins, M.S., & Szapocznik, J. (2000). Brief Structural Family Therapy with behavior problem youth. Office of Juvenile Justice and Delinquency Prevention Bulletin, Office of Justice Programs, U.S. Department of Justice, Washington, D.C.
Szapocznik, J., & Williams, R.A. (2000). Brief strategic family therapy: Twenty-five years of interplay among theory, research, and practice. Clinical Child & Family Psychology Review, 3, 11, 7-134.
Santisteban, D.A., Szapocznik, J., Perez-Vidal, A., Kurtines, W.M., Murray, E.J., & Lapierre, (1996). Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology, 10, 35-44.
Szapocznik, J., Rio, A., Murray, E., Cohen, R., Scopetta, M., Rivas-Vazquez, A., Hervis, O., Posada, V., & Kurtines, W. (1989). Structural family versus psychodynamic child therapy for problematic Hispanic boys. Journal of Consulting and Clinical Psychology, 57, (5) 571-578.
Szapocznik, J., Perez-Vidal, A., Brickman, A., Foote, F.H., Santisteban, D., Hervis, O.E., & Kurtines, W.M. (1988). Engaging adolescent drug abusers and their families into treatment: A Strategic Structural Systems approach. Journal Counseling & Clinical Psychology, 56, 552-557.