Defense Date


Document Type


Degree Name

Doctor of Philosophy


Clinical Psychology

First Advisor

Bryce D. McLeod


Family therapy is considered a well-established treatment approach for adolescent externalizing problems; however, research examining its effectiveness when delivered in routine practice settings has produced mixed results. The accurate interpretation of these inconsistent results requires an understanding of what therapeutic techniques were delivered, including those that were prescribed (i.e., adherence) and those that were non-prescribed (i.e., differentiation), suggesting the need for a measure that can concurrently assess treatment adherence and differentiation. The current study examined the extent to which an observational measure of an array of therapeutic techniques for youth emotional and behavioral problems (the Therapy Process Observational Coding System for Child Psychotherapy Revised Strategies Scale; TPOCS-RS) can assess both adherence to and differentiation from family therapy through psychometric assessment. Treatment sessions (N = 103) from 42 adolescents with primary externalizing problems treated by 24 therapists in routine practice settings were independently coded using the TPOCS-RS. Treatment sessions were from one of three groups: (a) usual care family therapy; (b) usual care family therapy plus the medication integration protocol; or (c) nonfamily therapy usual care. Adherence was represented by a TPOCS-RS Family Therapy subscale comprising the TPOCS-RS items considered to be core elements of family therapy for adolescent externalizing problems. Interrater reliability for the TPOCS-RS Family Therapy subscale was ICC = .90 and average interrater reliability for the other TPOCS-RS subscales was ICC = .83. The TPOCS-RS Family Therapy subscale scores demonstrated evidence of convergent and discriminant validity via associations with observer- and therapist-rated measures of adherence to family therapy, observer- and therapist-rated measures of non-family therapy techniques, and a measure of client-therapist alliance. The TPOCS-RS Family Therapy subscale also demonstrated evidence of discriminative validity by identifying expected group differences. Predictive validity was not supported. Results provide preliminary evidence that the TPOCS-RS can serve as a measure of adherence to, and differentiation from, family therapy in a population of adolescents with externalizing problems.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission