| Engagement in family therapy is considered to be a challenging task with adolescent members who resist the therapy process, and this task begins from the first moment of interaction (Liddle, 1995; Rubenstein, 2005). The term engagement in family therapy refers to a client's observable or self-reported experience of therapy as meaningful, a sense of involvement, and active negotiation of the goals and tasks of therapy with the therapist and with other family members (Friedlander, Escudero, & Heatherington, 2006). There is, however, little empirical research on how to do so, and exactly how therapists can create a shift from disengagement to engagement has yet to be studied.;The present discovery-oriented exploratory study was the initial stage in a task analysis of critical shifts in adolescent engagement that occur early in conjoint family therapy. The goal was to elucidate mechanisms of change by intensively analyzing four conjoint family therapy sessions in which a shift in adolescent engagement either did or did not occur. Results of the qualitative comparisons suggested that five therapist elements (structuring therapeutic interactions, fostering autonomy, building awareness of systemic issues, rolling with resistance, and understanding the adolescent's subjective experience) and one parent element (support) seem to be critical to a successful shift in adolescent engagement. Notably, verbal support from the parent (fostering a safe therapeutic environment and explicitly encouraging the adolescent to participate) was evident only in the two successful shift events.;The qualitative results were triangulated with quantitative data, specifically the adolescent's self-reported target complaints pre-treatment, session evaluations immediately following the session of interest, and total satisfaction scores at the end of therapy. Satisfaction scores reported by the adolescents in the two positive engagement events were notably higher than those reported by the adolescents in the unsuccessful events. Session evaluation scores for Smoothness were also somewhat higher for the two more engaged adolescents. Implications for practice are provided, along with a discussion of the study's strengths and weakness. Recommendations for future research are offered, related to (a) therapist and parent behaviors that facilitate adolescent engagement in conjoint therapy and (b) choosing intervention strategies based on the apparent reason for the adolescent's reluctance to engage. |
