The Emotionally-Focused Clinical and Research Training Program (EFCRTP) developed by Margaret Keiley, Research Director of the Marriage and Family Therapy Program, involves training students in the principles and practices of Emotionally-Focused Family Therapy (EFFT) and the Multiple Family Group Intervention (MFGI) for use with symptomatic adolescents or adults and their families. These two treatments have been shown to be clinically effective in reducing externalizing (e.g., aggression, violence, sex-offending, addiction) and internalizing (e.g., depression, eating disorders, cutting) behaviors. In the EFRCP students also are trained in the principles and practices of clinical research -- learning how to conduct quantitative and qualitative assessments as well as data analyses, how to write academic articles for publication, and how to prepare presentations for state and national conferences.

Statement of the Problem: Overall, a grave need exists for effective adolescent and adult mental health treatment. This need is exacerbated in correctional institutions which are focused mainly on punishment rather than treatment. An unfortunate, yet potentially preventable, vicious cycle exists in the lives of externalizing, internalizing, delinquent, addicted, and/or sexual offending adolescents or adults and their families. For example, every year, 70% of most states’ expenditures for adolescent mental health are for out-of-home placements (e.g., residential treatment, incarceration) (Henggeler, 1996). No controlled studies have been conducted that support the effectiveness of these treatments; instead, research indicates that restrictive out-of-home placements may have an appreciable negative impact (Sondheimer, Schoenwald, & Rowland, 1994). At present, many adolescents after release from correctional facilities return to delinquent behaviors, alcohol and drug abuse, and, at times, sexual offending (Santos et al., 1995). While incarcerated, no family treatment is offered or available. The result is that the coercive interactional patterns of these families do not improve (Patterson, 1982) and when adolescents leave the institutions they still are disconnected from their families, unable to cope well with conflict and negative emotion, and therefore less likely to integrate new information and develop alternative solutions to problems. Instead they are likely to revert to old, over-learned and often maladaptive behaviors, leaving them at risk for re-offending and relapse (Santos et al., 1995). Adolescents who are attached securely to their caregivers and able to regulate their emotion and arousal functionally are more successful in negotiating paths to adulthood than are those who are not (Cummings & Davies, 1996; Moore et al.,1998).

Development of MFGI (MFGI Manual Link): To meet these needs, I have been conducting research and publishing in areas of family therapy, emotion regulation, delinquency, and other high-risk behaviors. In my intervention-focused research, I first investigated emotion regulation and attachment in adjudicated and non-adjudicated youth and their families (e.g., Keiley & Seery, 2001). From this pilot work, I developed and piloted the Multiple Family Group Intervention (MFGI) for use with incarcerated adolescents and families to foster re-attachment and more functional emotion regulation. The theoretical basis of MFGI is the research on affect regulation and attachment; the clinical basis is Emotionally-Focused Therapy (EFT). In randomized clinical trials, EFT (Greenberg & Johnson, 1988) had proven to be effective in treating disruptive attachment and affect regulation patterns of couples and families with bulimic adolescents. In addition, research had shown that sex-offending, delinquent, and addicted adolescents and their families had attachment and affect regulation problems similar to those experienced by distressed couples and families with bulimic adolescents (Dodge, 1993). The MFGI is a 9-week manualized program in which parents and adolescents attend a weekly 90-minute psycho-education group that focuses on helping them re-regulate their emotions and re-attach to each other. MFGI uses video, discussion, role-play, and homework.

At Purdue University, my clinical team and I successfully conducted the MFGI at three Indiana correctional facilities over several years (Keiley, 2002a, 2002b). We also adapted the MFGI for use with incarcerated adults and their families who were struggling with addiction. Our qualitative data analysis indicated that adolescents and parents who had been through the MFGI program had improved relationships with each other, even if the adolescent had re-offended. The respondents also noted that they were very grateful to have had this opportunity to work together on family issues while the adolescent was still incarcerated. Many stated that they felt the MFGI provided a “missing piece” in the treatment options at the correctional facilities. Our quantitative data analyses (over 70 adolescents and families, (Evidence MFGI Link)) indicated that, although MFGI was effective in the short-term in reducing delinquent behavior and improving parent-adolescent relationships (6-month follow-up), it was a bit less successful in the long-term (12-month follow-up); approximately 20% of the adolescents had been re-incarcerated at one of the follow-up interviews.

Development of EFFT (EFFT Manual Link): Because many of the attachment and affect regulation difficulties these families experience are pervasive, intractable, and enduring, they require individual family therapy rather than a multiple-family group psycho-educational intervention (Keiley, 2001). Hence, I developed an adaptation of EFT to conduct individual family therapy (EFFT) with these families rather than MFGI. A key assumption of EFFT is that emotion is primary in organizing attachment behaviors in relationships and internal working models (IWMs). Key factors in relational distress are excessive levels of negative emotion and destructive and conflictual interactional patterns that arise from, reflect, and create negative emotion (Greenberg & Johnson, 1988). In EFFT, new emotional experiences and interactions with others are seen as necessary for change to occur in internal working models and hence in relationships. The EFFT process of change occurs in 3 stages, often completed in 9 to 12 sessions. Beginning sessions involve assessment and de-escalation of problematic interactional styles that maintain attachment insecurity and emotional distress. Middle sessions focus on the creation of specific change events, in which interactional positions shift. In these events, family members access the sadness and fear that underlie their distress or anger. The new bonding experiences that occur allow family members to support one another and begin to problem solve effectively. Final sessions address consolidation of change and integration of these changes into everyday life (Johnson, 1996). Studies of EFT (Greenberg, Ford, Alden, & Johnson, 1993; Greenberg & Johnson, 1988; Johnson & Talitman, 1997) have shown that it is effective in leading to positive shifts in interactional patterns. EFFT has proven to be an effective family treatment for interrupting cycles of coercive behavior that exist in families of incarcerated adolescents and adults. In fact, the resulting EFFT treatment is the first of its kind to address explicitly prior to the adolescent’s release from the institution: (1) attachment and affect regulation problems that underlie sex-offending, delinquency, and addiction, and (2) the severe attachment distress of incarceration for this population.

Mechanism of Change: The mechanism by which change occurs in these two treatments – MFGI and EFFT – is the alteration of the family members’ cognitive internal working models (IWMs) that influence their responses to conflict (Zimmerman, 1999). By changing these IWMs, the family members are able to de-escalate the coercive cycles and negative emotion that occur in these families allowing the adolescents and family members to create closer bonds (Moore et al., 1998). The development of this attachment security also curbs a relapse to delinquent behavior, substance abuse, and sexual offending by the adolescents (Cook, 2000).

Current Clinical and Research Project: This project includes the training of graduate students in the family therapy program, accredited by the American Association for Marriage and Family Therapy (AAMFT), and in other programs at Auburn University in understanding, designing, and conducting clinical research. The field of couple and family therapy recently has advocated the use of evidence-based therapy for treating families. Solid research on the process and outcome of some family therapy is available, but many treatments have not undergone treatment development or clinical trials. Unfortunately, most AAMFT accredited programs are not equipped to train graduate students to design and conduct excellent clinical research. This study will include the development of two practica in research methods which will include: (1) didactic and empirical experience conducting clinical trials; (2) didactic and empirical experience in collecting, managing, and analyzing longitudinal (growth analysis, survival analysis) and qualitative data. The current project involves conducting MFGI and EFFT at Mt. Meigs Department of Youth Services Facility with incarcerated sex-offending adolescents and their families. If you are interested in learning more about how you can become involved in this project, please email


Margaret Keiley.