Van der Pol et al. (2019). Common elements of evidence-based systemic treatments for adolescents with disruptive behaviour problems.” – Article summary

Identifying common elements between treatments could render them more effective. Many treatments have common elements yet a unique focus. This could help personalize the treatments. Knowing common elements of treatments allows therapists to implement these techniques in treatment more easily. Knowledge of treatment mechanisms and identification of potent treatment techniques can support enhanced precision in matching systemic treatments to the needs of adolescents and their families.

There are several common elements across individual systemic treatment protocols:

1. Engagement
   This refers to motivating and involving all the key agents to start the process of change. This includes matching (1), facilitating (2) and availability (3).
2. Alliance
   This refers to creating an atmosphere of positive bonds between the therapist, client and family members. This allows for consensual goal setting and establishing a foundation for positive change.
3. Interactional focus
   This refers to viewing family-parent interactions as stable patterns that need to change and the family members are viewed as a resource for change.
4. Developmental process
   This refers to individualizing the interventions and fostering developmental process. The therapeutic process is considered as phasic and continuity is stressed.
5. Relational assessments/evaluations
   This refers to assessing and evaluating the situation to be able to act swiftly and to choose the most effective interventions and techniques.
6. Here-and-now focus
   This refers to an emphasis on the here-and-now in the communication of and with the family. It is also used for resolving problems and crises.

The treatments typically had one to three sessions a week and lasted between three and 12 months. Conflict management and communication skills were techniques that are used in all systemic treatments. There are several common techniques in most systemic treatments:

1. Conflict management
   This refers to identifying and handling conflict in a sensible, fair and efficient manner.
2. Communication skills
   This refers to improving the way family members communicate.
3. Reinforcement
   This refers to making use of reinforcement.
4. Assigning and reviewing homework
   This refers to assigning and reviewing tasks to be completed between sessions.
5. Problem-solving
   This refers to generating alternative solutions, evaluating options, considering the consequences of each option and providing self-rewards.
6. Psychoeducation
   This refers to teaching through didactic instruction or explanation.
7. Anticipating and training for setbacks
   This refers to predicting future setbacks and relapse prevention.
8. Divert and interrupt
   This refers to interrupting a negative of blaming interaction between family members by diverting the negative speech-act to a more positive one.
9. Reframing
   This refers to changing the conceptual setting or viewpoint in relation to which the situation is experienced (i.e. change the meaning of the situation).
10. Reviewing goals and progress
    This refers to reviewing previous work and themes and progress toward meeting established goals.
11. Special time
    This refers to creating special quality time with the adolescents.
12. Limit-setting
    This refers to setting limits (e.g. time-out).
13. Enactment
    This refers to the therapist directing family members to talk or interact together about feelings and emotions to observe and modify problematic transactions.
14. Working with boundaries
    This refers to shift the alliances in a family.
15. Monitoring
    This refers to improving parental awareness of the adolescent’s activities and communication to the adolescent about concerns.
16. Reconnecting
    This refers to reconnecting positive feelings and emotions by talking about how the relationship was in the past. This is done in difficult and negative situations.

All techniques were applicable for the family, parents and adolescent with some exceptions. The divert and interrupt (1), limit-setting (2), enactment (3), monitoring (4) and enactment (5) were not applicable to adolescents. Limit-setting was not applicable to the family.