Scene‐Based Psychodramatic Family Therapy with troubled adolescents and parents: A pilot study

1 This is he pee e iewed e sion o he ollowing a icle: Maya, J. , Jiménez, L. , Lo ence, B. , Mo al, G. and Hidalgo, V. (2019), Scene‐Based Psychod ama ic Family The apy Wi h T oubled Adolescen s and Pa en s: A Pilo S udy. Fam. P oc., which has been published in inal o m a h ps://doi.o g/10.1111/ amp.12401. This a icle may be used o non-comme cial pu poses in acco dance wi h Wiley Te ms and Condi ions o Use o Sel -A chi ed Ve sions. 2 Scene-Based Psychod ama ic Family The apy wi h oubled adolescen s and pa en s. A pilo s udy Scene-Based Psychod ama ic Family The apy (SB-PFT) is an inno a i e ea men used wi h oubled adolescen s and hei pa en s o imp o e amily ela ionships and educe adolescen s’ p oblema ic beha io . I in eg a es he p inciples o amily he apy, psychod ama and mul iple- amily g oup me hodology. This esea ch is a pilo s udy o ob ain empi ical e idence on he SB-PFT he apeu ic p ocess by gauging he pe cep ion o change o oubled adolescen s and hei pa en s, and assess he pe cei ed help ulness o i s me hodology and echniques. Ten mul iple- amily in e en ion g oups we e d awn up, wi h 110 pa icipan s (63 adolescen s and 47 pa en s), and we adop ed a quali a i e me hodology wi h ocus g oups, using an induc i e analysis o 290 ac i e cons uc ions o pa icipan na a i es. Conce ning pe cep ion o change, he adolescen s epo ed mainly gaining in social suppo , p osocial a i udes, keys o p oblem sol ing and exp ession o emo ions due o he ea men . The pa en s pe cei ed imp o emen in social suppo , keys o educa ional p ac ices, emo ional well-being and exp ession o emo ions due o he ea men . Rega ding he pe cei ed help ulness o me hodology and echniques, bo h adolescen s and pa en s highligh ed he use ulness o he g oup me hodology o gaining social suppo , ela i izing he p oblem and exp essing emo ions. Addi ionally, pa icipan s e e ed o ole-playing and mi o echniques as he mos use ul. In conclusion, his i s s udy on SB-PFT p esen s and desc ibes i s ea men o oubled adolescen s and hei pa en s. The pa icipan s' posi i e pe cep ion o hei pe sonal and ela ional change a e ea men should se e o p omo e u he s udies wi h quan i a i e me hodology in o de o e i y he e ec i eness o SB-PFT ea men . 3 Keywo ds: amily he apy; psychod ama; oubled adolescen s; quali a i e me hodology. T oubled adolescen s a e cha ac e ized o a g ea ex en by mani es ing p oblema ic beha io s in he amily and social con ex such as opposi ional beha io , igh ing, lying, physical o e bal agg ession owa ds pa en s and pee s, episodes o absen eeism o expulsions om school and o he beha io s ha may in ol e being included in he c iminal jus ice sys em (Alexande , Wald on, Robbins, & Neeb, 2013; Sex on, 2011). The ela ionship be ween adolescen psychosocial adjus men and he amily con ex is widely suppo ed by s udies o adolescen de elopmen (Bámaca- Colbe e al., 2017; G eenbe g & Lippold, 2013). Thus, he amily is one o he social sys ems in which adolescen s main ain c ucial in e ac ions (Hunge e al., 2017). The amily sys em p o ides a amewo k o belonging which a ends o he needs, es ablishes links o us and p omo es au onomy (Hunge e al., 2017). Addi ionally, he e is also empi ical e idence linking p oblema ic beha io s du ing adolescence o a hos ile and con lic i e ela ionship wi h pa en s (Fosco, Lippold, & Feinbe g, 2014). Acco dingly, while ea men s ocusing on symp oms may ini ially educe he p oblem beha io , i he e is no in e en ion in he amily con ex and ela ionships, he p oblem beha io s will e-su ace (Sex on e al., 2011). P oblema ic beha io s a e jus he isible symp om ha he amily sys em and he adolescen a e in c isis. Consequen ly, indi idual change pa ly depends on changes in o he amily membe s, as all he sys em con ibu es and is a ec ed by he p oblem si ua ion (Pa e son, 2014). Family he apy has been highligh ed as a use ul s a egy o in e ening wi h he amily as a sys em when adolescen s exhibi p oblema ic beha io s (G eenbe g & Lippold, 2013). Ne e heless, wi h he excep ion o Mul isys emic The apy (Henggele , Schoenwald, Bo din, Rowland, & Cunningham, 2009), and Func ional Family The apy 4 (Sex on, 2011), he e a e as ye ela i ely ew e idence-based ea men s o in e ening wi h adolescen s wi h p oblema ic beha io s and hei pa en s. This would explain he cu en in e es in de eloping ea men s ha inc ease he esou ces o p o essionals o in e ening wi h oubled adolescen s and hei pa en s, and in ecen yea s we ha e seen he eme gence o new ea men s pa ially de i ed om amily he apy. These include Family Cons ella ions (FC; Cohen, 2006) which highligh in e es in ha ing e idence-based ea men o imp o e amily in e ac ions (Sex on e al., 2011). Spain has seen he de elopmen o Scene-based Psychod ama ic Family The apy (SB-PFT). This ea men has been posi i ely e alua ed by p o essionals wo king wi h adolescen s wi h p oblema ic beha io s and hei pa en s (Lo ence e al., 2018). SB-PFT is a no el ea men espec ing amily he apy p inciples ha inno a es in compa ison o o he sys emic app oaches wi h oubled adolescen s by adop ing a mul iple- amily g oup o ma , as well as by helping he adolescen s and hei pa en s o expe ience con lic si ua ions and assimila e o he ways o esol ing con lic s h ough psychod ama ic echniques. Scene-Based Psychod ama ic Family The apy (SB-PFT) SB-PFT is a speci ic he apeu ic ea men ha aims o imp o e amily ela ionships and educe adolescen s’ p oblema ic beha io (Lo ence, Díaz, & Maya, 2018; Gu ié ez, 2015). SB-PFT in eg a es he p inciples and echniques o sys emic amily he apy and he psychod ama ic model using a g oup me hodology, speci ically mul iple- amily g oups. SB-PFT includes assump ions de i ed om sys emic amily he apy, such as he impo ance o in ol ing all he amily membe s in he he apy, ocusing on dys unc ional amily ela ionships, unde s anding beha io al and emo ional symp oms as pa o he de e io a ion o amily ela ions, and aking in o accoun he pe cep ion, esou ces, and solu ions p oposed by he membe s o he amily sys em 5 (Minuchin & Fishman, 1981). SB-PFT d aws on he s eng hs o he pa icipan s in o de o enhance indi idual and amily change (Lo ence, e al., 2018). Acco ding o he psychod ama ic app oach, SB-PFT is based on he impo ance o he ac ion and in e pe sonal oles (Mo eno, 1946). SB-PFT places special emphasis on he de elopmen o app op ia e in e pe sonal oles, ha is, on he di e en beha io s, cogni ions and emo ions ha appea in he in e ac ion wi h o he people in di e en con ex s ( o example, in he adolescen , his ole as a child, as a iend, his ole in on o au ho i y, e ce e a). Thus, ole aining based on he acquisi ion o beha io al and emo ional s a egies adap ed o indi idual and amily needs (nego ia ion, emo ional unde s anding, exp ession o emo ions, e ce e a) is mean o acili a e he managemen o di e en con lic si ua ions (Bla ne , 2007). In ac , Mo eno (1946) belie ed ha in e pe sonal oles should be ained h ough ac ion as a way o imp o ing he pe sonal and social well-being o indi iduals. Speci ically, SB-PFT ocuses p ima ily on pa en - adolescen in e ac ion so ha adolescen s can ain hei ole acco ding o amily and social no ms, and pa en s can ain hei pa en ing ole acco ding o adolescen s' needs (Lo ence e al., 2018). SB-PFT uses he mul iple- amily g oup me hodology ha consis s o he apeu ically a ending o se e al amily sys ems conjoin ly (Keiley, Za emba- Mo gan, Da ubo-B own, Pyle, & Cox, 2015). The empi ical da a a ailable o his me hodology e eals ha mul iple- amily g oups a o in a- amily communica ion and empa hy (Keiley e al., 2015), p oblem sol ing (Keiley e al., 2015; O uche, D aucke , Alkha ab, Knop , & Mazu cyk, 2014), ela i iza ion o he p oblem (O uche e al., 2014), and a educ ion in adolescen s’ p oblema ic beha io (Keiley e al., 2015). Addi ionally, SB-PFT conside s g oup he apeu ic ac o s p oposed by Yalom and Leszcz (2005), among which we highligh he ca ha sis o he pa icipan s in he 6 g oup, he possibili y o mee ing o he people wi h he same p oblem, gaining insigh in o he eason o hei beha io s and emo ions, in e pe sonal lea ning among he membe s o he g oup, o he possibili y o co ec ing nega i e amily dynamics h ough he help o he o he membe s. SB-PFT uses i e main psychod ama ic echniques: ole-playing, ole e e sal, mi o , doubling and in e pola ion o esis ances (C uz, Sales, Al es, & Moi a, 2018; Kippe & Ri chie, 2003; Mo eno, 1946). Role-playing consis s o he d ama iza ion o he pa icipan s wi h he p o essional auxilia y ego in some in e pe sonal con lic s. Role e e sal is simila o ole-playing, al hough he p o agonis assumes he ole o he o he pa y in he con lic du ing he d ama iza ion wi h he aim o changing his o he poin o iew and gaining a be e unde s anding o he o he pa y. In he mi o echnique, he p o agonis does no d ama ize he con lic . Ano he pa icipan o he auxilia y ego assumes i s ole in d ama iza ion. In his way, he p o agonis is made awa e o his o he ac ions om he ou side. In he doubling echnique, i is he p o essional auxilia y ego who gi es oice o he pa icipan 's eelings and hough s when he p o agonis is unable o exp ess him o he sel . Finally, in e pola ion o esis ances consis s o changing he con lic si ua ion du ing d ama iza ion o ind ou how he p o agonis will ac i he si ua ion changes. In SB-PFT, con lic a ia ion is cha ac e ized by he di ec o gi ing he auxilia y ego an indica ion o exp ess mo e emo ions du ing ole- play. In addi ion o he psychod ama ic echniques, SB-PFT in oduces a new echnique in he he apeu ic p ocess: he scene. This echnique is used a he beginning o he session and consis s o he d ama iza ion o a amily con lic only by he expe auxilia y ego (Gu ié ez, 2015). Change mechanisms 7 The s udy o mechanisms o change is c ucial in any igo ous assessmen and i enables us o unde s and he p ocess o pe sonal ans o ma ion which occu s in pa icipan s du ing ea men (Sex on e al., 2011). SB-PFT a emp s o achie e a p ocess o change on he basis o p inciples o amily he apy and psychod ama. F om he sys emic pe spec i e, amily changes such as imp o emen in pa en -child communica ion, indi idual changes in he amily con ex such as de elopmen o empa hy, he exp ession o emo ions o educ ion o ha sh pa en ing, a e seen o ac as media o s owa ds achie ing a be e amily ela ionship and a educ ion in he p oblem beha io (Alexande e al., 2013; Sex on e al., 2011). Acco ding o he psychod ama ic app oach, he p ocess o change includes he ca ha sis o he pa icipan s by ollowing sequen ial aspec s: people’s sel -app aisal and e alua ion o hei ela ionships, he e ela ion and exp ession o hei emo ions, and he inal in eg a ion o hei hough s and emo ions (Kelle mann, 1984). This las poin in ol es he iden i ica ion and di e en ia ion o he emo ions, lea ning new coping s a egies, knowledge o in e pe sonal ela ionships, and gaining emo ional well-being. P esen s udy This pape p esen s he i s s udy o SB-PFT. Speci ically, we p esen he main cha ac e is ics o he ea men and a se o da a collec ed om he expe iences o he pa icipan s which we hope will encou age subsequen s udies and ul ima ely a igo ous e alua ion o SB-PFT. Cu en ly, he e is a g owing endency o use he quali a i e pe spec i e, bo h as a complemen o he quan i a i e pe spec i e and exclusi ely. This me hodology p o ides a de ailed pic u e abou pe cep ions, opinions, and eelings o di e en pa icipan s (Pa on, 2002). 8 Speci ically, we se he ollowing conc e e objec i es: a) gauge he pe cep ion o change o oubled adolescen s and hei pa en s; and b) examine he help ulness o SB- PFT me hodology and echniques o pa icipan s. Me hod S udy design This s udy is based on a quali a i e app oach wi h ocus g oups in o de o ob ain a mo e accu a e knowledge o SB-PFT om he con en exp essed by he pa icipan s. SB-PFT cons i u es a no el ea men , al hough widely implemen ed in Spain, ha is beginning o a ouse scien i ic in e es (Lo ence e al., 2018). In his amewo k, his s udy design allows us o disco e concep s and p o ide a heo e ical iew o da a s a ing om he assump ions o G ounded Theo y (S auss & Co bin, 1998), gi ing p io i y o pa icipan s' discou se o e esea che s' p e ious knowledge. Fo his pu pose, a se o analy ical guidelines om G ounded Theo y ha e been ollowed o gene a e induc i e esul s ega ding pe cei ed changes and help ulness o SB-PFT me hodology and echniques h ough a compa a i e da a analysis p ocess (Cha maz, 2005; S auss & Co bin, 1998). This s udy cons i u es he i s s ep in a la ge esea ch p ojec aimed a desc ibing and assessing he e ec i eness o Scene-Based Psychod ama ic Family The apy (SB-PFT) un by Child Wel a e Se ices (CWS) in p io i y a eas o sou he n Spain. These a eas a e cha ac e ized by a a ie y o isk ac o s such as socioeconomic (e.g., low income o low educa ional le el), con ex ual isks (e.g., uancy, high iolence in he neighbo hood) and psychological ac o s associa ed wi h pa en al unc ioning such as pa en al s ess (Cy , Euse , Bake mans, & an Ijzendoo n, 2010). CWS a e public se ices in p io i y a eas aimed a educing p oblema ic amily si ua ions; hei 9 ield o in e en ion includes en i onmen al changes such as modi ica ion o amily unc ioning (Jonson-Reid, 2004). CWS p ac i ione s e e ed amilies ecen ly en olled in CWS (p e ious wo yea s) o he SB-PFT ea men , i hey me he ollowing c i e ia: (a) amilies wi h oubled adolescen s be ween 11 and 18 yea s exhibi ing p oblema ic beha io s such as equen igh s wi h pee s, alcohol use, social con lic s o expulsions om school; (b) signi ican impai men o amily ela ions; (c) consen o ea men om bo h adolescen and pa en s. CWS p ac i ione s assessed p oblema ic beha io h ough physical and e bal agg essi eness, ange and hos ili y (Buss & Pe y, 1992). Inadequa e amily dynamics and he use o dys unc ional educa ional p ac ices de ined he de e io a ion o amily ela ionships (Lo be , Xu, Smi h, Bulling, & O’Lea y, 2014; Olson, Po ne , & La ee, 1985). The SB-PFT ea men SB-PFT de elope s ecommend an a e age o 10 weekly mul iple- amily g oup ea men sessions, each one las ing wo hou s (Lo ece e al., 2018). Two sys emic he apis s (di ec o s) and wo p o essional auxilia y egos wi h expe ise in psychod ama ic echniques lead each mul iple- amily g oup (Lo ence e ., 2018). The he apis s who lead he mul iple- amily g oup a e psychologis s and ha e aining in sys emic amily he apy and psychod ama acc edi ed by o icial en i ies. The auxilia y egos may be quali ied psychologis s, social wo ke s o social educa o s. The auxilia y egos a e ained in SB-PFT by ea men he apis s. This aining one yea p io o he applica ion o he ea men has he objec i e o p epa ing he auxilia y egos in he use o psychod ama ic echniques. SB-PFT in e enes in pa en -adolescen con lic s which a e ha ing a nega i e in luence on amily dynamics. Each SB-PFT session uns h ough i e phases: ini ial 16 p ocess o alida ion om di e en sou ces, acili a ing he eme gence o ca ego ies sha ed by di e en in o man s; in his s udy, h ough he compa ison o ca ego ies o simila o di e en con en be ween adolescen s and pa en s (C eswell, 2007); (d) pee e iew o in e -analy ic iangula ion (C eswell, 2007), con as ing he esul s o each esea che ’s coding, analyzing in g ea e de ail hose in which ag eemen was no eached; (e) in a-e alua o eliabili y (Miles & Hube man, 1994); his p ocedu e equi ed each esea che , oughly wo- hi ds o he ma e ial analyzed, o s a again and e-examine he codes; ( ) conside a ion o ou lie s, ha is, he analysis o da a ha poin ed in he opposi e di ec ion o he gene al s uc u e (Mays & Pope, 2000); (g) a mul i-in o man me hod h ough ocus g oups (Mays & Pope, 2000). Resul s Due o space cons ain s and he la ge size o he ables, all o he ables a e annexed as Suppo ing In o ma ion. They show examples o he discou se o pa icipan s in each ca ego y ha eme ged om he quali a i e analysis. Pe cep ion o change The in-dep h analysis o he pa icipan s’ discou se e ealed he changes pe cei ed by he pa icipan s, iden i ying 290 ac i e cons uc ions o na a i es ha e lec ed some kind o change. On he basis o he con en s, we g ouped hese na a i es in o 23 ca ego ies o con en s o change. Table S1 p esen s he con en s o change iden i ied by he adolescen s, hei equency o occu ence and an example om each ca ego y. We iden i ied 13 con en s o change in adolescen s. Adolescen s mani es ed ha hanks o SB-PFT hey had pe cei ed an inc ease in hei social suppo ne wo k, a change in hei a i udes which led o imp o ed amily and social adjus men , and new keys o p oblem sol ing. O he changes ha adolescen s men ioned equen ly we e a g ea e acili y o exp essing 17 hei emo ions and eelings, be e communica ion wi h hei pa en s, inc eased emo ional wellbeing o a educ ion in hei agg essi e beha io s. Table S1 also shows he changes ha pa en s pe cei ed in hei child en. Pa en s ag eed wi h hei child en in 7 ou o he 13 ca ego ies. Fo he pa en s, he mos impo an changes in he adolescen s in SB-PFT we e ela ed o g ea e exp ession o emo ion and eelings, a change in a i ude which in ol ed g ea e accep ance o amily and social no ms, new keys o p oblem sol ing and imp o ed emo ional wellbeing. The pa en s’ discou se also iden i ied ou con en s o change which he oubled adolescen s had no men ioned. O hese, pa en s highligh ed g ea e con ol o adolescen s’ impulsi e beha io , g ea e empa hy and an inc eased awa eness o why hei pa en s beha ed and hough as hey did. Table S2 p esen s he ca ego ies iden i ied by he pa en s, he equency o occu ence and an example o each con en . The pa en s iden i ied 11 con en s o change in his pilo s udy. The ac i e cons uc ions o pa en s’ na a i e indica ed mainly an inc ease in hei social suppo ne wo k a e SB-PFT, new unde s andings o educa ional p ac ices, g ea e exp ession o hei emo ions and eelings and imp o ed social wellbeing cha ac e ized by a g ea e p esence o eelings o peace and calm. O he con en s included be e communica ion wi h hei child en, mo e sel -awa eness ega ding hei own and hei child en’s beha io s, hough s and mo i a ions, and a g ea e pe cep ion o sel -con ol. Table S2 is comple ed wi h he changes ha he adolescen s pe cei ed in hei pa en s. He e adolescen s and pa en s coincided in only 4 ou o he 11 ca ego ies. The adolescen s e ealed ha a e SB-PFT hei pa en s had a g ea e unde s anding o hei child en’s beha io s and hinking, and showed g ea e empa hy. Fu he mo e, he adolescen s in o med abou changes in hei pa en s ha he la e had no men ioned. Speci ically, he adolescen s poin ed ou ha hei pa en s 18 showed less o e - eac i i y, mo e signs o a ec ion and g ea e p omo ion o hei child en’s au onomy. A syn hesis o he changes ha ha e eme ged in adolescen s and pa en s is p esen ed in Figu e 3. INSERT FIGURE 3 HERE Finally, i should be no ed ha he numbe o na a i es ha showed absence o changes in adolescen s and pa en s was negligible in compa ison wi h he p esence o pe cei ed changes. Only 3 o he pa en s’ na a i es and 9 o he adolescen s’ na a i es e lec ed absence o changes. Pe cei ed help ulness o me hodology and echniques Table S3 shows he me hodological and echnical aspec s which we e pe cei ed as help ul by he adolescen s and hei pa en s, he equency o occu ence and an example o he na a i e. Thus, in hei discou se adolescen s e e ed mainly o he help ulness o he g oup me hodology as a acili a o o social suppo and exp ession o emo ions. Fu he mo e, he adolescen s epo ed ha he g oup na u e o SB-PFT in oduced hem o o he adolescen s in hei same si ua ion. Likewise, he main echniques epo ed as help ul by adolescen s du ing he he apeu ic p ocess we e ole- playing, he mi o and in e pola ion o esis ance. Adolescen s epo ed ha hese echniques helped hem acqui e new s a egies o esol ing con lic s, exp ess hei emo ions and eelings, pe cei e pee suppo , e lec on hei si ua ion and imp o e sel - knowledge o hei hough s, beha io s and emo ions. Finally, he pa en s e ealed ha he g oup me hodology allowed hem o mee o he s in he same si ua ion, acqui e unde s anding o educa ional p ac ices, exp ess emo ions and o m a new social suppo ne wo k. Likewise, he pa en s highligh ed he impo ance o g oup cohesion and us o encou age hem o open up emo ionally. 19 Role-playing and mi o echniques had he mos e e ences in he pa en s’ discou se analysis and hey s a ed ha hese wo echniques had helped hem o imp o e hei educa ional s a egies, exp ess emo ions and imp o e hei sel -knowledge abou hei hough s, beha io s and emo ions. The pa en s also e e ed o he scene as one o he main echniques in SB-PFT which acili a ed he de elopmen o empa hy and a g ea e unde s anding o hei child en. Discussion This s udy has p esen ed, o he i s ime, he heo e ical and me hodological p inciples o SB-PFT, implemen ed wi h adolescen s wi h p oblema ic beha io s and hei pa en s in p io i y a eas. I has included an ex ensi e and de ailed accoun o he ea men o acili a e i s ep oduc ion in u u e applica ions. The p esen a ion o SB- PFT con ibu es o he sea ch o in e en ion and ea men esou ces o a speci ic popula ion – p oblema ic adolescen s and hei pa en s – which equi es he apeu ic in e en ion (Sex on, 2011). The s udy esul s a e discussed using a quali a i e and mul i-in o man me hodology o acili a e unde s anding o he con en s mani es ed by adolescen s and hei pa en s (T acy, 2010). These con en s, analyzed induc i ely h ough he open and axial coding o G ounded Theo y, allow us o espond o he objec i es o he s udy and ob ain a se ies o heo e ical implica ions o u u e e alua ions o SB-PFT. The i s s udy objec i e was o analyze he changes pe cei ed as a esul o he SB-PFT. Pa icipan s e e ed o changes in pa en -child in e ac ions (such as be e in a amily communica ion), indi idual changes in adolescen s (such as he appea ance o mo e p osocial and less con lic i e beha io s), indi idual aspec s o he pa en s (such as be e exp ession o emo ions and imp o ed sel -knowledge), and changes in he suppo ne wo k. Pe cep ion o change on di e en le els is impo an in hese 20 ea men s in e ening in he amily sys em. In ac , Sex on e al. (2011) an icipa ed ha i was impo an o achie e ela ional changes o p e en p oblema ic beha io s om eappea ing in adolescen s. Rega ding ela ional changes, one o he objec i es o SB-PFT is o imp o e amily ela ions by modi ying dys unc ional ela ions be ween adolescen s and hei pa en s. In amily he apy (Minuchin & Fishman, 1981) one o he elemen s which changes pa en -adolescen in e ac ions is he use o educa ional p ac ices be e sui ed o he needs o he adolescen . In SB-PFT, pa en s e ealed ha hey had modi ied hei ideas abou educa ional p ac ices, highligh ing he impo ance o using less coe ci e s a egies, while he adolescen s poin ed o speci ic aspec s o hei pa en s’ educa ional p ac ice which had changed, such as he use o less eac i e p ac ices. Fu he mo e, acco ding o sys emic amily he apy (Minuchin & Fishman, 1981), ano he impo an elemen e ealed by bo h pa en s and adolescen s, and which he e o e seems o be a di ec consequence o he SB-PFT, was he imp o emen in communica ion be ween hem. In gene al, pa en s and adolescen s e ealed changes in pa en -adolescen in e ac ions such as g ea e a en ion o he needs o he o he amily membe , and he p omo ion o au onomy ha co esponds o he unc ions o he amily as a social sys em (Hunge e al., 2017). The ac ha pa en s and adolescen s e e o imp o emen s in amily ela ions and changes in he o he membe o he amily sys em has o be posi i e o adolescen de elopmen and he amily clima e (Bámaca-Colbe e al., 2017; Hunge e al., 2017). In ela ion o he pe sonal changes e ealed by he adolescen s, we ound changes in p oblems o ei he a beha io al, cogni i e o emo ional na u e. The ac ha he adolescen s we e he eason o which he amilies we e e e ed o SB-PFT due o hei p oblema ic beha io s unde lines he impo ance o he ac i e cons uc ions o he 21 adolescen s e e ing o a dec ease in physical o e bal agg essi eness, and mainly he de elopmen o p osocial a i udes, such as accep ance o amily, social and school ules. Thus, adolescen s’ discou se on his poin would seem o be consis en wi h he objec i es o he ea men di ec ly ela ed o educing p oblema ic beha io s. Adolescen s also e e ed o cogni i e changes such as g ea e knowledge abou he keys o p oblem sol ing and deepe sel -knowledge. These esul s a e consis en wi h o he ea men s o amilies wi h oubled adolescen s (Robbins, Alexande , Tu ne , & Hollimon, 2016; Sex on, 2011), apa om he esul e e ing o an imp o emen in sel -knowledge, which has no been epo ed be o e. Finally, he adolescen s e ealed imp o emen s in hei emo ional skills such as be e exp ession o hei emo ions and g ea e emo ional wellbeing. These changes a e consis en wi h he use o he psychod ama ic echniques in SB-PFT whose objec i e is o acili a e he emo ional libe a ion (Kelle mann, 1984). F om sys emic p inciples, i is clea ha changes in he adolescen pa ly depend on changes in he o he amily membe s and all he sys em con ibu es o, and is a ec ed by, he p oblem si ua ion (Pa e son, 2014). Hence, his s udy analyzed he changes pe cei ed by he pa en s. Besides changes in hei educa ional p ac ices, he pa en s e ealed o he cogni i e and beha io al changes which we e no ini ially o eseen in he objec i es o SB-PFT. Pa en s epo ed g ea e sel -knowledge and mo e coping s a egies o he p oblems o daily li e. A an emo ional le el, pa en s epo ed be e exp ession o emo ions and imp o ed emo ional wellbeing, changes possibly acili a ed by he psychod ama ic o ien a ion o SB-PFT (Mo eno, 1946). Finally, adolescen s and pa en s coincided in men ioning imp o emen s in pe cei ed social suppo . Encou aging sou ces and esou ces o social suppo in he li es o hese amilies should be highligh ed as one o he g ea s eng hs o his 22 ea men . This esul is no jus ema kable o being he one e e ed o mos by he pa icipan s, bu also o he con i med bene i s o social suppo o pe sonal wellbeing, amily ela ions and coping wi h s ess (Cohen, 2004). The second objec i e was o p o ide e idence o he pe cei ed help ulness o he me hodology and echniques used in SB-PFT by oubled adolescen s and pa en s. They coincided in highligh ing he impo ance o he g oup me hodology o p omo ing social suppo . Thus, one o he no el ea u es o SB-PFT wi h espec o o he ea men s wi h adolescen s wi h p oblema ic beha io s is he use o mul iple- amily g oups, he main implica ion o which is he gene a ion o suppo ne wo ks. This esul is consis en wi h he g oup he apeu ic ac o s p oposed by Yalom and Leszcz (2005). In acco dance wi h hese au ho s, he pa icipan s e ealed how he g oup and he con idence eached be ween he amilies and he adolescen s had enabled hem o mee o he amilies wi h he same p oblem, exp ess hei emo ions and acili a e in e pe sonal lea ning among he membe s o he g oup. These esul s ie in wi h hose epo ed in in e en ions using mul iple- amily g oups (O uche e al., 2014). As o he echniques used in SB-PFT, bo h adolescen s and pa en s highligh ed he alue o ole-playing and he mi o . Coinciding wi h he opinion o psychod ama ic expe s (C uz e al., 2018; Mo eno, 1946), adolescen s and pa en s unde lined he impo ance o ole-playing o exp essing emo ions, imp o ing sel -knowledge, imp o ing he keys o educa ional p ac ices and pe cei ed suppo in he ep esen a ion o con lic i e si ua ions. Role-playing acili a es he s ep om discou se o ac ion and he ca ha ic p ocess in he pa icipan s (Kelle mann, 1984; Mo eno, 1946). Toge he wi h ole-playing, he pa icipan s alued he help ulness o he mi o echnique consis ing o he d ama iza ion o a si ua ion in which he p o agonis s ays ou o he d ama iza ion and his o he ole is played by he auxilia y ego o o he membe o he 23 g oup (C uz e al., 2018). This ecen s udy highligh ed he impo ance o he mi o o making p o agonis s become awa e o hei beha io s. In ou s udy, bo h adolescen s and pa en s made e e ences in hei discou ses o his echnique as a acili a o o he acquisi ion o keys o p oblem sol ing, o p omo ing e lec ion, imp o ing sel - knowledge and he pe cep ion o eeling suppo . In u n, he scene (Gu ié ez, 2015) is a new echnique p oposed by SB-PFT o opening he ea men sessions. I was e e ed o mo e by pa en s han by adolescen s as a echnique a o ing empa hy and knowledge abou o he amily membe s, al hough i was no e e ed o as much as ole- playing o he mi o . Finally, in con as o he s udy by Kippe and Ri chie (2003), he impo ance ha pa icipan s a ibu ed o echniques o ole e e sal and doubling was low. Globally, he changes pe cei ed by he pa icipan s a e he SB-PFT a e consis en wi h he objec i es o he ea men . Indeed, ha bo h he adolescen s and hei pa en s pe cei ed ela ional and indi idual changes ies in wi h he amewo k o SB-PFT’s sys emic heo e ical app oach. The e o e, as a heo e ical implica ion s emming om ou induc i e analysis (see Figu e 3), we ound ha he changes pe cei ed a di e en le els (pa en -adolescen in e ac ion; indi idual in he adolescen and in he pa en ; and he de elopmen o social suppo ) should se e as a guide o de eloping empi ical unde s anding abou he e ec s o his ea men . In addi ion, in an a ea whe e deduc i e s udies p e ailed, he quali a i e analysis on he help ulness o psychod ama ic echniques has inc eased unde s anding on a heme wi h ew scien i ic con ibu ions om an induc i e poin o iew (C uz e al., 2018). The e o e, pa icipan s’ e e ences o he u ili y o echniques such as ole-playing and he mi o , and he bene i s men ioned o he g oup me hodology gi e us a posi i e ision o he SB-PFT, which is highly g a i ying o he p oblema ic adolescen s and hei pa en s. 24 Limi a ions and u u e esea ch The e we e se e al limi a ions in his s udy ha should be conside ed when in e p e ing he indings. A he me hodological le el, he e may ha e been d awbacks wi h he ocus g oups such as he in luence ha some pa icipan s may ha e exe ed o e he es o he g oup. Addi ionally, he ques ions selec ed may ha e in luenced he pa icipan s and se ed as guidelines o pa icipan s o epo posi i e changes o sa is y esea che s’ expec a ions. Likewise, he ques ions may ha e hinde ed he gene a ion o ela ionships and a inal heo y ha link he con en s o pe cei ed changes and he pe cei ed bene i o he me hodology and echniques o he SB-PFT. Fu he mo e, we had o pe o m h ee e iews o he da a be o e eaching consensus a ings due o di e ing le els o knowledge o he coding p ocess amongs esea che s. Hence, he esul s should be ea ed wi h cau ion and need o be con as ed a a la e s age wi h quan i a i e app oaches ollowing quali y s anda ds in p og amme e alua ion (Flay e al., 2005). Addi ionally, i would ha e been in e es ing o explo e he componen s o ea men s ha did no help. A he heo e ical le el, we mus bea in mind ha oubled adolescen s a e no a homogeneous popula ion (Sex on, 2011) and he e o e he indi idual di e ences mus be aken in o accoun in he s udy design. As o imp o emen s o u u e s udies, we p opose ha he esul s p esen ed in his pape mus be complemen ed by o he s udies o e alua e SB-PFT exhaus i ely wi h a mul i-me hod design comple ing he collec ion and analysis o da a wi h quan i a i e p ocedu es in a andomized con olled ial. I would also be in e es ing o conduc mo e s udies o be able o gene alize he esul s ob ained, es ablish an in eg a ion and explana ion o he SB-PFT change model and s udy he ole o possible in e en ion mode a o s. The inco po a ion o all hese imp o emen s would allow compliance wi h all he p inciple quali y c i e ia o e idence-based p ocedu es (Flay e 25 al., 2005). As o ways o imp o ing SB-PFT, we make h ee sugges ions: a) p omo e in e en ion componen s o encou age he de elopmen o empa hy amongs he adolescen s; b) ain pa en s in new educa ional p ac ices; c) enhance he use o he echniques o ole e e sal, doubling and he scene so hey a e pe cei ed as mo e help ul by pa icipan s; and d) de elop s a egies du ing he he apeu ic p ocess o make pa icipan s awa e o hei pe sonal s eng hs. Conclusions Despi e he a o emen ioned limi a ions, he use o an induc i e and open me hodology o analyze he pa icipan s’ discou se e ealed a wide ange o pe cei ed changes. The esul ing con en s will delimi he dimensions ha mus be e alua ed in quan i a i e s udies. Hence, his wo k, suppo ed by he assump ions o G ounded Theo y, has gene a ed he i s empi ical indings abou SB-PFT. Fu he mo e, his s udy has p esen ed he heo e ical and me hodological amewo k o he SB-PFT. Addi ionally, he s uc u e o he SB-PFT sessions and echniques ha e been desc ibed o encou age eplica ion by o he p o essionals. In conclusion, his s udy should help unde s anding o he he apeu ic p ocess behind SB-PFT and se e as a i s s ep owa ds imp o ing he in e en ion and esea ch o SB-PFT wi h adolescen s wi h p oblema ic beha io s and hei pa en s. Re e ences Alexande , J.F., Wald on, H.B., Robbins, M.S., & Neeb, A.A. (2013). Func ional amily he apy o adolescen beha io p oblems. Washing on, DC: Ame ican Associa ion. Bámaca-Colbe , M.Y. Gonzales-Backen, M. Hen y, C.S., Kin, P.S.Y., Roblye , M.Z., Plunke , S.W., & Sands, T. (2017). Family p o iles o cohesion and pa en ing