Program history

MDFT arose from a desire to transform the treatment services landscape in the adolescent substance abuse and delinquency specialties. A core objective has been to make widely available a personally engaging, science-based, clinically effective, and doable approach.

Today MDFT is implemented in various locales across the U.S. and Canada as well as in seven European countries.

The story of how MDFT became a leading model of adolescent treatment

MDFT was developed by Howard Liddle, professor of public health sciences, psychology, and counseling psychology at the University of Miami Miller School of Medicine. A counseling psychologist and family therapist, Dr. Liddle brought together interests in treatment research, intervention development, and therapist training. Liddle was inspired by and trained clinically under Salvador Minuchin, and Jay Haley at the Philadelphia Child Guidance Clinic in the mid-1970s. A decade later, he worked with Braulio Montalvo to refine clinical supervision methods that would become a core part of MDFT. While working and teaching in community-based clinics over the years, Liddle was struck by the multiple risks and difficulties, and complex clinical needs of clinically referred adolescents. Liddle realized “…in their own ways, the parents and adolescents themselves were teaching us what treatment needed to be, and how it could be effective.” MDFT became a new kind of family therapy - a comprehensive, systemic, and developmentally oriented approach. This way of working (Liddle, 1999) coordinates individual work and interventions with the youth and the parent(s), direct family relationship interventions, as well as interventions that focus on changes in the relationship systems outside of the family that influence the daily lives of the adolescent and family. Liddle’s determination to help adolescents and families find a healthy life path, coupled with concerns about the absence of available and science-supported adolescent interventions, led to his development of MDFT, a family-based treatment program for adolescents with substance abuse and serious behavior problems.

Over the next 25 years, Liddle, Dakof, Rowe, and colleagues tested the program in randomized controlled trials with demographically, socioeconomically, ethnically and culturally diverse populations around the United States (San Francisco Bay Area; Philadelphia, PA; Miami-Dade and Pinellas County Florida). Process studies focused on refining the treatment, testing its components, and applying new versions of the approach in a range of real-world settings. Dr. Liddle has taught the MDFT approach in twenty countries around the world since the late 1980s. Results showed that the program yielded statistically significant, clinically meaningful, and lasting youth and family outcomes. These findings are consistent across symptom severity levels, including samples including multiply impaired adolescents. MDFT helps restore healthy development to the lives of adolescents and their families, and enables parents and teens to renew their relationships with each other.

Under the leadership of Director Dr. Gayle Dakof, clinicians are trained to the same level of fidelity required in MDFT-controlled trials. In 2002, MDFT implementation began in the state of Connecticut with the Department of Children of Families and five community-based agencies. Demonstrating the sustainability of the MDFT approach, today all five  agencies continue to implement successful MDFT programs. Since this initial statewide collaboration, MDFT implementation has grown considerably. In Connecticut for example, today there are more than 20 MDFT programs employing over 100 full time clinicians. Over 120 MDFT teams operate in other states in the U.S. and in Europe.

MDFT International, a 501(c)(3) non-profit, was established in 2010 to facilitate quality replication of the MDFT program across the U.S. and Canada. MDFT International provides initial and ongoing implementation support to community settings in substance abuse, mental health, juvenile justice, and child welfare practice settings. The MDFT Academy, based in The Hague in the Netherlands, supports MDFT implementation throughout Europe. There are MDFT programs in eight Western European nations, and MDFT Academy develops new MDFT sites.

Today, Liddle and colleagues at the Center for Treatment Research on Adolescent Drug Abuse at the University of Miami Miller School of Medicine continue to develop new variations of the approach, study the model's long-term effects, and conduct research to improve the MDFT program.

Additional background:

Liddle, H., Rowe, C., Dakof, G., & Lyke, J. (1998). Translating parenting research into clinical interventions for families of adolescents. Clinical Child Psychology and Psychiatry, 3(3), 419-443.

Liddle, H. (1999). Theory development in a family-based therapy for adolescent drug abuse. Journal of Clinical Child Psychology, 28(4), 521-532.

Liddle, H., Rowe, C., Diamond, G., Sessa, F., Schmidt, S., & Ettinger, D. (2000). Toward a developmental family therapy: The clinical utility of research on adolescence. Journal of Marital and Family Therapy, 26(4), 485-500.

Liddle, H. (2004). Family-based therapies for adolescent alcohol and drug use: Research contributions and future research needs. Addiction, 99(Suppl. 2), 76-92.

Liddle, H. (2010). Treating adolescent substance abuse using Multidimensional Family Therapy. In J. Weisz & A. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd edition, pp. 416-432). N.Y.: Guilford.