History

“In their own way, the parents and adolescents themselves were teaching us what treatment needed to be, and how it could be effective.”

— Dr. Howard Liddle

MDFT originated from a desire to transform the treatment services landscape for youth mental health, substance use and delinquency. A core objective of MDFT has been to create a personally engaging, science-based, clinically effective, and practical approach. MDFT began in 1985 as part of a National Institute on Drug Abuse (NIDA)-funded randomized controlled trial (RCT) designed to test different treatments for adolescent substance misuse and delinquency.

Howard Liddle, Ed.D. and Gayle Dakof, Ph.D. developed MDFT beginning in the mid-1980s in the San Francisco Bay Area. The MDFT approach has been inspired by the clinical work of Salvador Minuchin, Jay Haley and others at the Philadelphia Child Guidance Clinic (PCGC), and the supervision methods of Braulio Montalvo, also of the PCGC. While working and teaching in community-based clinics over these foundational years, Drs. Dakof and Liddle were struck by the multiple risks, difficulties and complex clinical needs of clinically referred youth. They saw that treating youth and helping their families requires therapists to go beyond family therapy, parent management training, or individual or group therapy approaches with youth. The complexities of youth and family problems indicated the need for an integrative model bringing together the most powerful tools to address individual, parent, family and community risk factors and bolster protective processes using a systematic, outcomes-driven, team-based approach.

MDFT became a new kind of family therapy - a comprehensive, systemic, and developmentally oriented model. The developers’ determination to help youth and families create a positive life trajectory, coupled with concerns about the absence of available science-supported youth interventions, were critical to MDFT’s development. The development of MDFT was significantly influenced by research on adolescence and parenting being published at the same time – research on authoritative parenting, attachment styles, risk and resilience, ecological models, identity and autonomy development, peer relationships, and developmental psychopathology that guided the MDFT developers in what, how, and with whom to intervene.

In the 1990s, Dr. Cindy Rowe became a key member of the treatment development, training, and research teams based at Temple University and University of Miami School of Medicine. Over four decades, Drs. Liddle, Dakof, Rowe, and others have tested MDFT in RCTs with demographically, socioeconomically, ethnically and culturally diverse populations in North America and Europe (read more about these trials here). Ten RCTs provide consistent outcome evidence on the intervention’s clinical effectiveness. These studies have been done in community-based usual care settings in comparison to other high quality, manualized treatments.

Four other kinds of studies comprise the MDFT evidence base. Therapy process studies have illuminated the model’s clinical interior and defined process factors that mediate proximal and distal outcomes. Economic analyses have demonstrated the favorable cost benefits of using the MDFT approach in usual care settings. Implementation studies have described the model’s scalability and integration into treatment environments, including substance misuse, mental health, criminal justice, and child welfare care sectors. Adaptation studies have demonstrated the flexibility of the MDFT approach across populations and settings. MDFT has been successfully adapted to work with a range of youth, from early adolescents to transitional age young adults (TAY). Recent adaptations focused on specific clinical challenges (e.g., youth diagnosed or at very high risk of Opioid Use Disorder (OUD), youth with online/internet gaming problems) and clinical settings (e.g., drug courts clients, and inpatient/residential treatment).

MDFT International, a 501(c)(3) non-profit, was established under the leadership of Dr. Dakof in 2011 to facilitate the highest quality replication of the MDFT program. MDFT International provides initial and ongoing implementation support to community settings in substance misuse, mental health, juvenile justice, and child welfare practice settings. Our European partners established an MDFT training academy, which operates in the Netherlands through Stichting Jeugdinterventies (SJI). Currently, there are over 150 MDFT programs in the U.S. and Europe.