Family assessment and therapy in CAP — structured clinical viva

Assessment order. Safety (abuse, IPV, suicide, medical) → confidentiality contract → genogram and structure → circular sequences → multi-informant diagnosis → EE proxies and accommodation if relevant → package selection. Multi-partiality: ally with each member against the pattern, not against a villain parent.^[6]

Package logic for this stem. Serious multiproblem antisocial + school/peer issues → MST ecological intensity or high-fidelity functional FFT; prominent substance domain → MDFT. Not PCIT (too young-age model), not FBT (not AN), not ABFT alone if conduct/substance dominate — though attachment repair themes may still inform engagement.^[1][2][3]

EE. Criticism/hostility/EOI as interpersonal stress predictors of worse course — not proof parents caused the illness. High parental criticism here is a treatment target (communication skills, problem-solving), not a moral verdict.^[4]

Medication. No tablet treats family dysfunction; treat comorbidity only with indication, monitoring, and shared decision-making alongside the family package.^[1][6]

Hard refusal. Coercive holding therapy is contraindicated (APSAC). Explain harm risk and offer non-coercive alternatives in writing if needed.^[5]

Fidelity. Community FFT benefit tracks therapist adherence — implementation quality is examinable.^[3]