The SORT approach in family therapy

In the United States, prevalence rates for drug use and abuse has consistently risen, thus causing this phenomenon to be considered a great public health and social concern. “Lifetime incidence of alcohol and drug abuse is nearly 20%,” (Liddle & Dakof, 511) while “epidemiological data revealed that 9% of adolescent females and 20% of adolescent males meet adult diagnostic criteria for an alcohol use disorder,” (American Academy of Pediatrics, 1026). Furthermore, while studies have shown that substance abuse has increased over the past decade, it is also occurring at younger ages. This increase in use and abuse is cause for great concern, as usage during adolescence is “associated with a more rapid progression into addiction, delayed entry into adult roles (that is, adult relationships, employment, and so forth), and high societal costs,” (Smith & Hall, 185). Due to the over-whelming prevalence of drug use and abuse amongst adolescents, the likelihood of addiction, future predictions of impaired social functioning, and societal costs of this disorder, it is imperative that treatment options for adolescents with substance abuse problems be expanded, (Smith & Hall, 2008).

In their article, Strengths-oriented family therapy for adolescence abuse problems, Smith & Hall (2008) explore a “treatment program, developed by social workers, called Strengths-Oriented Family Therapy (SORT),” (p.185). The SOFT approach utilizing many aspects from previous, established approaches, but have developed three aspects which are unique to it’s approach; (1) a pretreatment family motivational enhancement session called the Strengths-Oriented Referral for Teens (SORT), (2) a foundation in solution-focused language and treatment techniques, and (3) a formal strengths and resources assessment in the early stages of treatment. Overall, this approach, while aimed to help the adolescent client suffering from addiction, largely incorporates the entire family unit. The authors’ belief in the effectiveness of this approach lies in their position that the family unit and relationships and parenting style can predict adolescent drug use. The basis of this approach is founded in the principles of motivational interviewing, ex. discussing the adolescents' strengths and weaknesses, and solution-focused counseling thereby increasing one’s ability to employ positive coping techniques.

The SOFT program usually lasts 12 weeks, during which the family participates in a cumulative of 30 hours of therapy, in a combination of individual, family, and multifamily group sessions. The program itself is divided into 3 main parts, stages 1,2, and 3. In the first stage, the family is asked to evaluate the strengths of their child and their family as a whole. This process allows for therapy to begin on a good note and provides reference and reminders to the positive attributes of each family member. This aspect is an important component to the SORT therapy, so that as the family discusses the difficult aspects of the family functioning and weaknesses of each individual, that they do not “lose sight” of the strengths. Of course, if there are immediate or life and death concerns that need to be addressed during this stage, the therapist will work on these as well, however the focus will be on building a positive relationship between the family members themselves as well as the therapist.

Stage 2 of the SORT approach implements aspects of solution-focused therapy whereas each client will develop a set of goals that they intend to achieve throughout the course of their treatment. During this phase, the clients will be asked to reflect on coping methods, behaviors and approaches that have successfully worked in the past that they could explore and apply to current situations. Then individually, the clients will outline the steps that they specifically can take to achieve their treatment goals. The counselor will assist the client in making attainable goals and focusing on small tasks that added together will result in the outcomes that they hope to gain.

Once the clients have been able to identify their goals and complete some of the tasks they had set forth, they will move on to Stage 3. In stage 3, the counselor and family will reflect on their original goals and evaluate their progress. If necessary the client’s plans can be modified, however, it is important to recognize and praise the success, regardless of how minuet, that the clients have made thus far. Once the family has achieved their desired goals, therapy will be concluded.

As a future therapist and one who currently works with children in an educational and counseling setting, she finds that the SORT approach provides numerous benefits and could easily be employed in her practice. In the domestic abuse shelter in which she works, she often finds that the clients struggle with issues of self-esteem, dependency, and often their previous environment has denoted that their focus be on survival more than on their own mental health concerns. Mothers, often over-whelmed, fail to acknowledge the positive attributes of their children, and even as adults feel that they have very little to offer to others. Furthermore, in abusive relationships, where the abuser uses methods to maintain power and control over their victims, the victim finds themselves “put down,” degraded and often feels worthless. With these characteristics in mind, one could see how, especially stage 1, focusing on the strengths of each individual, could benefit all members of the family and aid in the rebuilding of their relationship. Additionally, prior to the clients’ arrival at the shelter, they had been in a situation where they were powerless, unable to make there own decisions, be in control, and see out a plan for success. In using the SORT approach, the counselor could teach the client this process, with constant reassurance, thereby allowing the client to take control of their destiny.

In the future, this writer intends to work with individuals struggling with substance abuse issues, and while she finds that this approach could work well with domestic abuse clients, she also believes that it would be applicable those who have issues with addiction. She maintains that these two areas are quite similar to each other, in that both sets of clients struggle with issues of addiction, the first set are addicted to the abuser and their situation and the latter to substances. Similarly, both sets of clients struggle with issues of self-esteem, acceptance, goal-oriented behaviors and have relinquished their power either to the drug or to the abuser, furthermore, the clients in both scenarios struggle with guilt and embarrassment over their decision to remain in their situation. With these thoughts in mind, it would seem that the SORT approach could easily be implemented with both sets and provide positive results.

References
American Academy of Pediatrics. (2001). Improving substance abuse prevention, assessment, and treatment financing for children and adolescents. Pediatrics 108(4), 1025–1029.
Liddle, H.A. & Dakof, G.A. (1995). Efficacy of family therapy for drug abuse: Promising but not definitive. Journal of Marital and Family Therapy, 21(4), 511.
Smith, D.C. & Hall, J.A. (2008). Strengths-oriented family therapy for adolescents with substance abuse problems. Social Work, 53(2), 185-188.

Stephanie Lowrance-Henckel